Individual
JENNA RENEE SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
1801 N SENATE BLVD STE 400, INDIANAPOLIS, IN 46202-1245
(317) 944-9400
(317) 963-3289
Mailing address
6638 CAPE NEDDICK CT APT J, INDIANAPOLIS, IN 46217-8772
(812) 774-6752
Taxonomy
Speciality
Code
Description
License number
State
2080S0010X
Pediatric Sports Medicine Physician
36003333A
IN
2083S0010X
Sports Medicine (Preventive Medicine) Physician
36003333A
IN
2255A2300X
Athletic Trainer
Primary
36003333A
IN
Other
Enumeration date
08/26/2020
Last updated
01/06/2021
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