Provider Demographics
NPI:1962043612
Name:SPRADLIN, RENEE (APRN)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:SPRADLIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 WALNUT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8033
Mailing Address - Country:US
Mailing Address - Phone:859-552-2578
Mailing Address - Fax:
Practice Address - Street 1:480 BULLION BLVD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2933
Practice Address - Country:US
Practice Address - Phone:859-385-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily