Healthcare Provider Details

I. General information

NPI: 1104074830
Provider Name (Legal Business Name): JENNIFER KAY SPRAKER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2008
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N 16TH ST
NEW CASTLE IN
47362-4319
US

IV. Provider business mailing address

7639 BAYVIEW CLUB DR APT 3C
INDIANAPOLIS IN
46250-2470
US

V. Phone/Fax

Practice location:
  • Phone: 765-521-0890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number99034126A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: