Healthcare Provider Details

I. General information

NPI: 1306027297
Provider Name (Legal Business Name): J-PIA KIM SPRUILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 COMMERCE DR
AURORA MO
65605-6260
US

IV. Provider business mailing address

3800 S NATIONAL AVE STE. 540
SPRINGFIELD MO
65807-5209
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-2400
  • Fax: 417-269-2410
Mailing address:
  • Phone: 417-269-2400
  • Fax: 417-269-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2007015334
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: