Provider Demographics
NPI:1285696740
Name:SPELL, MICHAEL K (APRN-BC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:K
Last Name:SPELL
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Gender:M
Credentials:APRN-BC
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Mailing Address - Street 1:3070 COLLEGE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4691
Mailing Address - Country:US
Mailing Address - Phone:409-813-1677
Mailing Address - Fax:409-951-1690
Practice Address - Street 1:3070 COLLEGE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4691
Practice Address - Country:US
Practice Address - Phone:409-813-1677
Practice Address - Fax:409-951-1690
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2007-10-30
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Provider Licenses
StateLicense IDTaxonomies
TX670960363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q74561Medicare UPIN