Provider Demographics
NPI:1386164879
Name:SPRAGUE, JAMEE (AGNP-C)
Entity type:Individual
Prefix:
First Name:JAMEE
Middle Name:
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:JAMEE
Other - Middle Name:
Other - Last Name:SPRAGUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGNP-C
Mailing Address - Street 1:1120 N MELVIN ST
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936-1477
Mailing Address - Country:US
Mailing Address - Phone:217-784-2245
Mailing Address - Fax:
Practice Address - Street 1:705 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOOPESTON
Practice Address - State:IL
Practice Address - Zip Code:60942-1904
Practice Address - Country:US
Practice Address - Phone:217-283-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.016058363LC0200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209.016058OtherADVANCED PRACTICE NURSE LICENSE