Provider Demographics
NPI:1558189548
Name:SPENCER, KAMIA I (RN)
Entity type:Individual
Prefix:
First Name:KAMIA
Middle Name:I
Last Name:SPENCER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 BLYTHE AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-5214
Mailing Address - Country:US
Mailing Address - Phone:215-301-4206
Mailing Address - Fax:
Practice Address - Street 1:410 BLYTHE AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-5214
Practice Address - Country:US
Practice Address - Phone:215-301-4206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN710360163WP2201X
PASP030890363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care