Provider Demographics
NPI:1619614377
Name:SPEARS, MCKENSI AN INEZ (BS, CSW)
Entity Type:Individual
Prefix:
First Name:MCKENSI
Middle Name:AN INEZ
Last Name:SPEARS
Suffix:
Gender:F
Credentials:BS, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 EXECUTIVE PL APT B
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5113
Mailing Address - Country:US
Mailing Address - Phone:575-740-5167
Mailing Address - Fax:
Practice Address - Street 1:900 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-6600
Practice Address - Country:US
Practice Address - Phone:575-740-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-15
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty