Provider Demographics
NPI:1831722966
Name:SPROLES, ASHA P (NP)
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:P
Last Name:SPROLES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:509 MED TECH PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2579
Mailing Address - Country:US
Mailing Address - Phone:423-302-6567
Mailing Address - Fax:423-952-2175
Practice Address - Street 1:1 MEDICAL PARK BLVD FL 5
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-6000
Practice Address - Fax:423-844-6027
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN27375363LP0808X
TN194780163W00000X
VA0024179054363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse