MEDICARE: KELLY ANN SPAID NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	5004026	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588724769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ANN SPAID NP

Provider Business Mailing Address
First Line	:	PO BOX 344
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27102-0344
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:	336-716-6937

Provider Business Practice Location Address
First Line	:	500 SHEPHERD ST
Second Line	:	SUITE 500
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1633
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:	336-716-6937

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	01/26/2011

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