Provider Demographics
NPI:1386602019
Name:SPAYD, JESSICA J (ANP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:SPAYD
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16425 BROOKS LOOP
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8027
Mailing Address - Country:US
Mailing Address - Phone:907-622-4673
Mailing Address - Fax:907-622-4672
Practice Address - Street 1:16425 BROOKS LOOP
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8027
Practice Address - Country:US
Practice Address - Phone:907-622-4673
Practice Address - Fax:907-622-4672
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKANP677363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP9295Medicaid
1295849446OtherNPI
AK421538019OtherCOMMERCIAL PAYER ID (EIN)
AKK152739Medicare PIN
1295849446OtherNPI
AK421538019OtherCOMMERCIAL PAYER ID (EIN)