Provider Demographics
NPI:1194190306
Name:SPRAGUE, JOHNNA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JOHNNA
Middle Name:
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S. JEFFERSON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501
Mailing Address - Country:US
Mailing Address - Phone:931-526-7246
Mailing Address - Fax:931-526-7369
Practice Address - Street 1:620 S. JEFFERSON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501
Practice Address - Country:US
Practice Address - Phone:931-526-7246
Practice Address - Fax:931-526-7369
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily