Healthcare Provider Details

I. General information

NPI: 1265368385
Provider Name (Legal Business Name): ROBERT WADE SPILMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 HITT ST FL 4
COLUMBIA MO
65212-1002
US

IV. Provider business mailing address

2101 CORONA RD APT 208
COLUMBIA MO
65203-5905
US

V. Phone/Fax

Practice location:
  • Phone: 573-499-6084
  • Fax: 573-499-6088
Mailing address:
  • Phone: 573-499-6084
  • Fax: 573-499-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number2022026325
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: