Provider Demographics
NPI:1417751520
Name:SPROUL, KATHERINE LYNN (DMD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LYNN
Last Name:SPROUL
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6993 COLLEGE CT APT 4-204
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-7196
Mailing Address - Country:US
Mailing Address - Phone:727-366-3105
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 9402
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-9402
Practice Address - Country:US
Practice Address - Phone:304-293-5831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program