Provider Demographics
NPI:1083315659
Name:SPIKES, KEVIN MITCHELL (FNP)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MITCHELL
Last Name:SPIKES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 PIEDMONT RD NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3636
Mailing Address - Country:US
Mailing Address - Phone:229-569-0815
Mailing Address - Fax:
Practice Address - Street 1:4800 OLDE TOWNE PKWY STE 320
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4357
Practice Address - Country:US
Practice Address - Phone:678-341-6370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN278291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily