Individual
JENNIFER TERESA SPRAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10506 MONTGOMERY RD STE 200A, MONTGOMERY, OH 45242-4400
(513) 865-2227
(513) 865-5552
Mailing address
2300 CHAMBER CENTER DR, LAKESIDE PARK, KY 41017-1686
(859) 301-4723
(859) 301-4724
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.005482RX
OH
363A00000X
Physician Assistant
TC639
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2565399
—
OH
Enumeration date
09/20/2017
Last updated
09/16/2021
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