Individual
TESSA SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
HC 31, BOX 310, DEER, AR 72628
(870) 428-5391
(870) 428-5392
Mailing address
HC 31 BOX 310, DEER, AR 72628
(870) 428-5391
(870) 428-5392
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A005003
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150794749
—
AR
05
—
222932758
—
AR
01
—
566466
BCBS
AR
01
—
5B477
MEDICARE
AR
01
—
DA1111
RAILROAD MEDICARE
AR
Enumeration date
02/07/2017
Last updated
11/20/2018
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