Provider Demographics
NPI:1295460426
Name:SPRAGUE, KRISTIANNA SUE (NP)
Entity Type:Individual
Prefix:
First Name:KRISTIANNA
Middle Name:SUE
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4572 MARILYN ST
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-9653
Mailing Address - Country:US
Mailing Address - Phone:614-668-7667
Mailing Address - Fax:
Practice Address - Street 1:4572 MARILYN ST
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-9653
Practice Address - Country:US
Practice Address - Phone:614-668-7667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00042135363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily