MEDICARE: MRS. SYKETHA SPRAGUE RN, NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP2201X	Ambulatory Care Registered Nurse	CA563543	CA
2	363LF0000X	Family Nurse Practitioner	21283	CA
3	163WC0200X	Critical Care Medicine Registered Nurse	RN158320	AZ
4	363LF0000X	Family Nurse Practitioner	C-APN.0000051-C-NP	CO

General Provider Information

NPI Number	:	1528115235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SYKETHA SPRAGUE RN, NP-C

Provider Business Mailing Address
First Line	:	2091 KAHALA CIR
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-2799
Country	:	US
Telephone Number	:	623-570-7587
Fax Number	:

Provider Business Practice Location Address
First Line	:	88 INVERNESS CIR E
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80112-5304
Country	:	US
Telephone Number	:	303-790-6449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	05/23/2015

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