Provider Demographics
NPI:1932210325
Name:SPENCER, NICHOLE T (ARNP)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:T
Last Name:SPENCER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2944 W 123RD TER
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2407
Mailing Address - Country:US
Mailing Address - Phone:913-484-2959
Mailing Address - Fax:
Practice Address - Street 1:8901 W 74TH ST
Practice Address - Street 2:STE 147
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2204
Practice Address - Country:US
Practice Address - Phone:913-432-8400
Practice Address - Fax:913-432-8402
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45944363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSN92F050Medicare PIN
KSP00376131Medicare PIN