1851672141 NPI number — MRS. KERI DAWN SPENCER NP-C

Table of content: MICHAEL WAYNE MONTGOMERY MA, ATC, LAT, LMT (NPI 1689643116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851672141 NPI number — MRS. KERI DAWN SPENCER NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPENCER
Provider First Name:
KERI
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BELL
Provider Other First Name:
KERI
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851672141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HEARTLAND HOME HEALTH & HOSPICE
Provider Second Line Business Mailing Address:
2872 N RIDGE ROAD SUITE 122
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67205-1144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-788-7626
Provider Business Mailing Address Fax Number:
316-721-5306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HEARTLAND HOME HEALTH & HOSPICE
Provider Second Line Business Practice Location Address:
2872 N RIDGE ROAD SUITE 122
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67205-1144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-788-7626
Provider Business Practice Location Address Fax Number:
316-721-5306
Provider Enumeration Date:
08/31/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  53-75445-111 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)