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NPI Code Detail

MEDICARE: KELLY LYNN SPROUT M.D.

MEDICARE: KELLY LYNN SPROUT M.D.
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
12084P0800XPsychiatry Physician72088OH

General Provider Information

NPI Number : 1659422129
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY LYNN SPROUT M.D.
Provider Business Mailing Address
First Line : 1925 HAYES AVE
Second Line :
City : SANDUSKY
State : OH
Zip : 44870-4737
Country : US
Telephone Number : 419-557-5177
Fax Number :
Provider Business Practice Location Address
First Line : 1925 HAYES AVE
Second Line :
City : SANDUSKY
State : OH
Zip : 44870-4737
Country : US
Telephone Number : 419-557-5177
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2007
Last Update Date : 12/05/2019

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Directions to “ KELLY LYNN SPROUT M.D.” Practice Location

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