Healthcare Provider Details

I. General information

NPI: 1386164879
Provider Name (Legal Business Name): JAMEE SPRAGUE AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMEE SPRAGUE AGNP-C

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 S DIXIE HWY
HOOPESTON IL
60942-1904
US

IV. Provider business mailing address

1120 N MELVIN ST
GIBSON CITY IL
60936-1477
US

V. Phone/Fax

Practice location:
  • Phone: 217-283-5530
  • Fax:
Mailing address:
  • Phone: 217-784-2245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.016058
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number209.016058
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: