Provider Demographics
NPI:1043407828
Name:SPINNEY, KRISTIN L (PAC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:SPINNEY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3812
Mailing Address - Country:US
Mailing Address - Phone:978-462-9571
Mailing Address - Fax:978-462-1459
Practice Address - Street 1:18 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3812
Practice Address - Country:US
Practice Address - Phone:978-462-9571
Practice Address - Fax:978-462-1459
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP2367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant