Provider Demographics
NPI:1063855864
Name:SPICER, KERRIE E (FNP)
Entity Type:Individual
Prefix:
First Name:KERRIE
Middle Name:E
Last Name:SPICER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KERRIE
Other - Middle Name:E
Other - Last Name:HAYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:6951 NOTTINGHAM DR NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-3483
Mailing Address - Country:US
Mailing Address - Phone:503-881-3698
Mailing Address - Fax:
Practice Address - Street 1:1049 EDGEWATER ST NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-4046
Practice Address - Country:US
Practice Address - Phone:503-814-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201600082NP-PP363LF0000X
OR200340946RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse