Provider Demographics
NPI:1740450402
Name:SPRINKLE, JERRY L
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:L
Last Name:SPRINKLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 TELL ST
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-2138
Mailing Address - Country:US
Mailing Address - Phone:812-547-4229
Mailing Address - Fax:812-547-2057
Practice Address - Street 1:801 TELL ST
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-2138
Practice Address - Country:US
Practice Address - Phone:812-547-4229
Practice Address - Fax:812-547-2057
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-08
Last Update Date:2008-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1331959 IN344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi