Provider Demographics
NPI:1053479089
Name:SPADY, JODI E (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:E
Last Name:SPADY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JODI
Other - Middle Name:E
Other - Last Name:MERRIHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:NE
Mailing Address - Zip Code:69033-0157
Mailing Address - Country:US
Mailing Address - Phone:308-882-7294
Mailing Address - Fax:308-882-7300
Practice Address - Street 1:600 W 12TH ST
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:NE
Practice Address - Zip Code:69033-3130
Practice Address - Country:US
Practice Address - Phone:308-882-7299
Practice Address - Fax:308-882-7300
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2008-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1211363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE280914Medicare PIN
NEQ51502Medicare UPIN