Healthcare Provider Details

I. General information

NPI: 1588724769
Provider Name (Legal Business Name): KELLY ANN SPAID NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SHEPHERD ST SUITE 500
WINSTON SALEM NC
27103-1633
US

IV. Provider business mailing address

PO BOX 344
WINSTON SALEM NC
27102-0344
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2255
  • Fax: 336-716-6937
Mailing address:
  • Phone: 336-716-2255
  • Fax: 336-716-6937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5004026
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: