Healthcare Provider Details

I. General information

NPI: 1164037784
Provider Name (Legal Business Name): ELIZABETH SPRAY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7370 TURFWAY ROAD
FLORENCE KY
41042-4896
US

IV. Provider business mailing address

529 MILES CT
UNION KY
41091-7585
US

V. Phone/Fax

Practice location:
  • Phone: 859-212-0497
  • Fax: 859-282-1141
Mailing address:
  • Phone: 859-630-7247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3014465
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3014465
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: