Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APRN88700-PMHNP-BC | WV |
NPI | 1013499029 |
---|---|
Provider Name | Spencer Kissel |
First Address | Davenport, IA 52804-1707 |
Second Address | Gallipolis, OH 45631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2018 |
Last Update Date | 19/04/2021 |