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NPI Code Detail

MEDICARE: AMANDA KALYCA SPRAGUE PA-C

MEDICARE: AMANDA KALYCA SPRAGUE PA-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
1363A00000XPhysician AssistantPA.0005826CO
2364SP0808XPsychiatric/Mental Health Clinical Nurse SpecialistPA9344AZ
3363A00000XPhysician AssistantPA9344AZ

General Provider Information

NPI Number : 1871146811
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA KALYCA SPRAGUE PA-C
Provider Business Mailing Address
First Line : 3101 N CENTRAL AVE STE 550
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2635
Country : US
Telephone Number : 602-230-7373
Fax Number : 602-682-7455
Provider Business Practice Location Address
First Line : 235 W WESTERN AVE
Second Line :
City : AVONDALE
State : AZ
Zip : 85323-1848
Country : US
Telephone Number : 602-230-7373
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2019
Last Update Date : 12/23/2025

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Directions to “ AMANDA KALYCA SPRAGUE PA-C” Practice Location

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