Provider Demographics
NPI:1578839007
Name:SPROUSE, KENYA (CRT)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:SPROUSE
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 STURBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-8550
Mailing Address - Country:US
Mailing Address - Phone:901-283-7899
Mailing Address - Fax:
Practice Address - Street 1:4850 STURBRIDGE LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-8550
Practice Address - Country:US
Practice Address - Phone:901-283-7899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4325227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified