Provider Demographics
NPI:1649974122
Name:SPEAR, KRISTA S
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:S
Last Name:SPEAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S. JACKSON ST.
Mailing Address - Street 2:2ND FLOOR ACB, DEPARTMENT OF SURGERY
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 S. JACKSON ST.
Practice Address - Street 2:2ND FLOOR ACB, DEPARTMENT OF SURGERY
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:734-904-3004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2024-04-12
Deactivation Date:2024-03-18
Deactivation Code:
Reactivation Date:2024-04-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program