Healthcare Provider Details

I. General information

NPI: 1306581392
Provider Name (Legal Business Name): ALYSSA D SPROUSE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5933 BLAKENEY PARK DR STE 200
CHARLOTTE NC
28277-5763
US

IV. Provider business mailing address

6035 FAIRVIEW RD
CHARLOTTE NC
28210-3256
US

V. Phone/Fax

Practice location:
  • Phone: 704-295-3311
  • Fax: 704-295-3322
Mailing address:
  • Phone: 704-295-3000
  • Fax: 704-295-3468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5023563
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1070148
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: