Active NPI
Jillian Hernandez Sprague, CPNP
- Pediatric Nurse Practitioner
- Wilmington, DE
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 5011666
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | LJ-0010479 | DE | |
| Nurse Practitioner | 363L00000X | LJ-0010479 | DE | |
| Pediatric Nurse Practitioner | 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 310313 | NC | MD | Registered Nurse |
| LJ-0010479 | DE | MD | Nurse Practitioner |
| 5011666 | NC | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jeffers Mann & Artman Pediatric & Adolesent Medicine PA | Single Specialty | Current | 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.
-
- Pediatric Adolescent Medicine Physician
- Raleigh, NC
- NPI 1962466631
Single Specialty
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.