Provider Demographics
NPI:1679628697
Name:SPEARS, DAMON SCOTT (RN,MSN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:DAMON
Middle Name:SCOTT
Last Name:SPEARS
Suffix:
Gender:M
Credentials:RN,MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701B ROBB ST
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666-8241
Mailing Address - Country:US
Mailing Address - Phone:601-608-0900
Mailing Address - Fax:
Practice Address - Street 1:701B ROBB ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:MS
Practice Address - Zip Code:39666-8241
Practice Address - Country:US
Practice Address - Phone:601-608-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR852829163W00000X, 163WE0003X, 163WF0300X, 163WU0100X
MS901999363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WF0300XNursing Service ProvidersRegistered NurseFlight
No163WU0100XNursing Service ProvidersRegistered NurseUrology