Provider Demographics
NPI:1992056782
Name:SPRY, JENNIFER R (PA-C)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:R
Last Name:SPRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 HEARTHSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-3593
Mailing Address - Country:US
Mailing Address - Phone:931-607-1981
Mailing Address - Fax:
Practice Address - Street 1:2525 DESALES AVENUE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA,
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:931-607-1981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2216363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical