Provider Demographics
NPI:1568121440
Name:SPENCER, KIMBER L (RN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBER
Middle Name:L
Last Name:SPENCER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:KIMBER
Other - Middle Name:L
Other - Last Name:HESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7239 N MAIN STREET EXT
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-9679
Mailing Address - Country:US
Mailing Address - Phone:607-382-0957
Mailing Address - Fax:
Practice Address - Street 1:7331 N MAIN STREET EXT
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-9678
Practice Address - Country:US
Practice Address - Phone:607-382-0957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY726974-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse