MEDICARE: KIRK EVERETT SPELMAN NP

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	363L00000X	Nurse Practitioner	RN2272160	MA

General Provider Information

NPI Number	:	1518393438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK EVERETT SPELMAN NP

Provider Business Mailing Address
First Line	:	101 ACADEMY DR
Second Line	:
City	:	BUZZARDS BAY
State	:	MA
Zip	:	02532-3405
Country	:	US
Telephone Number	:	508-830-5048
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 ACADEMY DR
Second Line	:
City	:	BUZZARDS BAY
State	:	MA
Zip	:	02532-3405
Country	:	US
Telephone Number	:	508-830-5048
Fax Number	:

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

Provider Enumeration Date	:	09/24/2013
Last Update Date	:	09/24/2013

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