Healthcare Provider Details

I. General information

NPI: 1801857065
Provider Name (Legal Business Name): MABLE R. SPELL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2734 S HIGHWAY 421
MANCHESTER KY
40962-7515
US

IV. Provider business mailing address

PO BOX 1125
CORBIN KY
40702-1125
US

V. Phone/Fax

Practice location:
  • Phone: 606-599-0609
  • Fax: 606-599-8419
Mailing address:
  • Phone: 606-528-0283
  • Fax: 606-528-8422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number255P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: