Provider Demographics
NPI:1801857065
Name:SPELL, MABLE R (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MABLE
Middle Name:R
Last Name:SPELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1125
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-1125
Mailing Address - Country:US
Mailing Address - Phone:606-528-0283
Mailing Address - Fax:606-528-8422
Practice Address - Street 1:2734 S HIGHWAY 421
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-7515
Practice Address - Country:US
Practice Address - Phone:606-599-0609
Practice Address - Fax:606-599-8419
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY255P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78-000205Medicaid
KYR38188Medicare UPIN
KY78-000205Medicaid