Provider Demographics
NPI:1225552789
Name:SPRAGUE, KELSEY ANN (EMT BASIC 426241)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:ANN
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:EMT BASIC 426241
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 LUDINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14206-1446
Mailing Address - Country:US
Mailing Address - Phone:716-997-2780
Mailing Address - Fax:
Practice Address - Street 1:481 WILLIAM L GAITER PKWY
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-2731
Practice Address - Country:US
Practice Address - Phone:716-882-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY426241146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic