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General NPI Number Information
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NPI Number | 1013499029
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Entity Type | Individual
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Provider Name | SPENCER KISSEL
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Gender | Male
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 1284 STATE ROUTE 160
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City | GALLIPOLIS
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State | OH
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Zip | 45631
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Country | US
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Telephone | 912-409-8533
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 W CENTRAL PARK AVE
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City | DAVENPORT
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State | IA
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Zip | 52804-1707
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Country | US
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Telephone | 563-421-1785
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN88700-PMHNP-BC
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License Number State | WV
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