Provider Demographics
NPI:1053707372
Name:SPRAGUE, MEGHANN ELISE (MD)
Entity type:Individual
Prefix:DR
First Name:MEGHANN
Middle Name:ELISE
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEGHANN
Other - Middle Name:ELISE
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 PACIFIC AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-1903
Mailing Address - Country:US
Mailing Address - Phone:360-782-1700
Mailing Address - Fax:
Practice Address - Street 1:555 PACIFIC AVE STE 202
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337-1903
Practice Address - Country:US
Practice Address - Phone:360-782-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD607795312084P0800X
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1053707372Medicaid