Healthcare Provider Details

I. General information

NPI: 1497537336
Provider Name (Legal Business Name): SUSAN HART SPENCE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE STE D201
LEXINGTON KY
40536-0284
US

IV. Provider business mailing address

740 S LIMESTONE STE D201
LEXINGTON KY
40536-0284
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-0079
  • Fax:
Mailing address:
  • Phone: 859-323-0079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA3329
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA3329
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3329
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: