Provider Demographics
NPI:1356613970
Name:SPENCER, KELLY RUTHANNE (ARNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:RUTHANNE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4600 MILITARY TRL
Mailing Address - Street 2:#122
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4810
Mailing Address - Country:US
Mailing Address - Phone:561-743-4911
Mailing Address - Fax:561-743-2998
Practice Address - Street 1:4600 MILITARY TRL
Practice Address - Street 2:#122
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4810
Practice Address - Country:US
Practice Address - Phone:561-743-4911
Practice Address - Fax:561-743-2998
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9248154363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily