Provider Demographics
NPI:1588193221
Name:SPENCER-ION, KIMBERLEY LYNN (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:LYNN
Last Name:SPENCER-ION
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 E BIG BEAVER RD
Mailing Address - Street 2:STE 111
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1421
Mailing Address - Country:US
Mailing Address - Phone:248-244-8545
Mailing Address - Fax:248-244-8582
Practice Address - Street 1:2536 N WILLIAMS LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1054
Practice Address - Country:US
Practice Address - Phone:313-802-0797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704210198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine