Healthcare Provider Details

I. General information

NPI: 1932210325
Provider Name (Legal Business Name): NICHOLE T SPENCER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 W 74TH ST STE 147
SHAWNEE MISSION KS
66204-2204
US

IV. Provider business mailing address

2944 W 123RD TER
LEAWOOD KS
66209-2407
US

V. Phone/Fax

Practice location:
  • Phone: 913-432-8400
  • Fax: 913-432-8402
Mailing address:
  • Phone: 913-484-2959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number45944
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: