Provider Demographics
NPI:1679395347
Name:SPICER, GABRYELLE MYCHELE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:GABRYELLE
Middle Name:MYCHELE
Last Name:SPICER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1433
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-1433
Mailing Address - Country:US
Mailing Address - Phone:606-218-6011
Mailing Address - Fax:606-218-6082
Practice Address - Street 1:255 CHURCH ST STE 102B
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3476
Practice Address - Country:US
Practice Address - Phone:606-218-6011
Practice Address - Fax:606-218-6082
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4029659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4029659OtherAPRN