NPI 1902886567 · live from the CMS NPI Registry
Avera Mckennan
Family Medicine in Spencer, IA. National Provider Identifier 1902886567, active.
NPI record
| NPI | 1902886567 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Family Medicine 207Q00000X |
| Practice location | 116 E 11th St, Suite 101, Spencer, IA 51301 |
| Practice phone | 712-264-3500 |
| Enumerated | January 19, 2006 |
| Last updated | March 12, 2012 |
| Authorized official | Julie Norton, V.P. Finance |
| Other names | Avera Medical Group Spencer |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant | 363A00000X | — (IA) |
| Nurse Practitioner, Family | 363LF0000X | — (IA) |
| Nurse Practitioner, Pediatrics | 363LP0200X | — (IA) |
| Family Medicine primary | 207Q00000X | — (IA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.