Provider Demographics
NPI:1942907928
Name:HEALTHY SPROUTS AND HOUSE CALLS, PLLC
Entity Type:Organization
Organization Name:HEALTHY SPROUTS AND HOUSE CALLS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CMO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:JEANSONNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-863-5173
Mailing Address - Street 1:3966 BLOOMINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7004
Mailing Address - Country:US
Mailing Address - Phone:423-863-5173
Mailing Address - Fax:423-765-0616
Practice Address - Street 1:3966 BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7004
Practice Address - Country:US
Practice Address - Phone:423-863-5173
Practice Address - Fax:423-765-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty