1114236643 NPI number — DR. BRITTNEY JALYNN SPROUSE AU.D.

Table of content: DR. BRITTNEY JALYNN SPROUSE AU.D. (NPI 1114236643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114236643 NPI number — DR. BRITTNEY JALYNN SPROUSE AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPROUSE
Provider First Name:
BRITTNEY
Provider Middle Name:
JALYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114236643
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12020 SHELDRAKE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PICKERINGTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43147-8622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-703-3689
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 CHILDRENS DR
Provider Second Line Business Practice Location Address:
SUITE 2A, OCC
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43205-2664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-722-5875
Provider Business Practice Location Address Fax Number:
614-722-3904
Provider Enumeration Date:
10/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  A.01695 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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