Sparks, Shelly Renae

Sparks, Shelly Renae is an individual health care provider with primary practice located at 1515 N Madison Ave , Anderson IN 46011-3453. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Gerontology, which is considered as her primary health care specialty. Sparks, Shelly Renae can be contacted via phone (317) 621-4900.

Contact Information

Primary practice address
1515 N Madison Ave Anderson IN 46011-3453
Phone: (317) 621-4900
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X 71001150A Indiana

Profile Details

NPI number 1962420109
LBN Legal business name Sparks, Shelly Renae
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 17th, 2006
Last updated May 26th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962420109 NPPES
Indiana MEDICAID 200357660

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