Individual
JACKIE D SPROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1001 E 2ND ST, COUDERSPORT, PA 16915-8179
(814) 274-5320
Mailing address
1001 E 2ND ST, COUDERSPORT, PA 16915-8179
(814) 274-9300
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP019776
PA
Other
Enumeration date
02/21/2019
Last updated
04/02/2021
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