Individual
AMITY BLYTHE SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
859 E MELTON DR, JAY, OK 74346-2704
(918) 253-1761
Mailing address
PO BOX 350, JAY, OK 74346-0350
(918) 253-1761
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R0094749
OK
Other
Enumeration date
03/15/2021
Last updated
03/15/2021
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