MEDICARE: MR. KEVIN MITCHELL SPIKES FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	40900	TN
2	363LF0000X	Family Nurse Practitioner	31579	SC
3	363LF0000X	Family Nurse Practitioner	RN278291	GA
4	363LF0000X	Family Nurse Practitioner	3-002757	AL
5	363LF0000X	Family Nurse Practitioner	C-APN.0105834-C-NP	CO

General Provider Information

NPI Number	:	1083315659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN MITCHELL SPIKES FNP

Provider Business Mailing Address
First Line	:	3801 OXFORD WAY E
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-4160
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 OXFORD WAY E
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-4160
Country	:	US
Telephone Number	:	229-569-0815
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	05/19/2026

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