Provider Demographics
NPI:1215712427
Name:SPELL, KINSLEY
Entity type:Individual
Prefix:
First Name:KINSLEY
Middle Name:
Last Name:SPELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 EULA LEE RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-1021
Mailing Address - Country:US
Mailing Address - Phone:912-269-0075
Mailing Address - Fax:
Practice Address - Street 1:10 EULA LEE RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-1021
Practice Address - Country:US
Practice Address - Phone:912-269-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program