Provider Demographics
NPI:1952852147
Name:SPENCER, KYLE (KCPM)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:SPENCER
Suffix:
Gender:M
Credentials:KCPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 S CHAUTAUQUA AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-5615
Mailing Address - Country:US
Mailing Address - Phone:316-312-8557
Mailing Address - Fax:
Practice Address - Street 1:2017 S CHAUTAUQUA AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-5615
Practice Address - Country:US
Practice Address - Phone:316-312-8557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-22
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist