Provider Demographics
NPI:1720447733
Name:SPERRY, CHAD (APN)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:SPERRY
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 S US HIGHWAY 231
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-9421
Mailing Address - Country:US
Mailing Address - Phone:765-307-7146
Mailing Address - Fax:765-307-7260
Practice Address - Street 1:1130 MOHAWK HILLS DR APT C
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2825
Practice Address - Country:US
Practice Address - Phone:317-698-7009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28202586A163WP2201X
IN71006374A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care