Individual provider Active NPI

Jillian Hernandez Sprague, CPNP

  • Pediatric Nurse Practitioner
  • Wilmington, DE
National Provider Identifier
1770099319
Registry record updated Oct 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
5011666 Issued in NC
Practice address
501 W 14TH St
Wilmington, DE 19801-1013
Phone
(302) 428-4410
Fax
(302) 428-4078
NPI assigned
Dec 19, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X LJ-0010479 DE
Nurse Practitioner 363L00000X LJ-0010479 DE
Pediatric Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0200X 5011666 NC Primary
Registered Nurse 163W00000X 310313 NC

Addresses

Primary practice location

501 W 14TH St
Wilmington, DE 19801-1013

Mailing address

2406 Blue Ridge Rd Ste 100
Raleigh, NC 27607-6692
Phone (919) 786-5001

Other practice location 1

2406 Blue Ridge Rd Ste 100
Raleigh, NC 27607-6692
Phone (919) 786-5001

Other practice location 2

104 Medspring Dr Ste 100
Clayton, NC 27520
Phone (919) 359-3500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241021000277 DE Order and Referring Only - Nurse Practitioner 2860924479

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
310313NCMDRegistered Nurse
LJ-0010479DEMDNurse Practitioner
5011666NCMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jeffers Mann & Artman Pediatric & Adolesent Medicine PA Single Specialty CurrentSince Jan 1, 2022 Accepting new patients

Locations

104 Medspring Dr
#100
Clayton, NC 27520
Phone (919) 359-3500

2406 Blue Ridge Rd
Ste 100
Raleigh, NC 27607
Phone (919) 786-5001

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1513641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728259200000",
    "number": "1770099319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2406 BLUE RIDGE RD STE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276076692",
            "telephone_number": "919-786-5001",
            "fax_number": "919-786-5051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 W 14TH ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198011013",
            "telephone_number": "302-428-4410",
            "fax_number": "302-428-4078"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2406 Blue Ridge Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276076692",
            "country_code": "US",
            "telephone_number": "919-786-5001",
            "fax_number": "919-786-5051",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "104 Medspring Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Clayton",
            "state": "NC",
            "postal_code": "27520",
            "country_code": "US",
            "telephone_number": "919-359-3500",
            "fax_number": "919-359-3501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPRAGUE",
        "first_name": "JILLIAN",
        "middle_name": "HERNANDEZ",
        "credential": "CPNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-19",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "DE",
            "license": "LJ-0010479",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "DE",
            "license": "LJ-0010479",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5011666",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "310313",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, DE

Sources for this page

Verify at the official NPI Registry.