Provider Demographics
NPI:1366988339
Name:SPRAGUE, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 COPPERAS RD
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026-4838
Mailing Address - Country:US
Mailing Address - Phone:785-364-7300
Mailing Address - Fax:573-234-4799
Practice Address - Street 1:910 N COLLEGE AVE STE 4
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4797
Practice Address - Country:US
Practice Address - Phone:636-642-1215
Practice Address - Fax:573-234-4799
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-13
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77498363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health