Individual
JOHN RYAN SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
13395 N MARANA MAIN ST, MARANA, AZ 85653-7008
(520) 682-4111
Mailing address
13395 N MARANA MAIN ST, MARANA, AZ 85653-7008
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN197580
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
233011
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
590524
—
AZ
Enumeration date
08/19/2019
Last updated
07/22/2021
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