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General NPI Number Information
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NPI Number | 1255465720
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Entity Type | Organization
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Legal Business Name | JESSICA SPAYD
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 11823 OLD GLENN HWY SUITE 110
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City | EAGLE RIVER
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State | AK
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Zip | 99577-7734
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Country | US
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Telephone | 907-622-4673
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Fax | 907-622-4674
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Provider Business Mailing Address
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Address Line | 11823 OLD GLENN HWY SUITE 110
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City | EAGLE RIVER
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State | AK
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Zip | 99577-7734
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Country | US
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Telephone | 907-622-4673
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Fax | 907-622-4674
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | JESSICA J SPAYD
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Credential | ANP
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Telephone | 907-622-4673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4245, 677, 20608
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 4245, 677, 20608
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 4245, 677, 20608
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License Number State | AK
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 4245, 677, 20608
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License Number State | AK
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Taxonomy #5
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 4245, 677, 20608
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License Number State | AK
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Taxonomy #6
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4245, 677, 20608
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License Number State | AK
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Taxonomy #7
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 4245, 677, 20608
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License Number State | AK
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