Provider Demographics
NPI:1063245819
Name:SPRAGGINS, KALIF STEPHON
Entity type:Individual
Prefix:
First Name:KALIF
Middle Name:STEPHON
Last Name:SPRAGGINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 RUE CONGE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-2550
Mailing Address - Country:US
Mailing Address - Phone:337-442-4013
Mailing Address - Fax:
Practice Address - Street 1:120 RUE CONGE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-2550
Practice Address - Country:US
Practice Address - Phone:337-442-4013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA21951552343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)