Individual
MS. TRACEY DYAN SPAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N
Contact information
Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 341-7246
Mailing address
44 NICOLE DR, INDEPENDENCE, KY 41051-7317
(859) 359-0191
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1118099
KY
163W00000X
Registered Nurse
RN 322985
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
085937
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000702876
ANTHEM
—
05
—
201008860
—
IN
05
—
3125620
—
OH
01
—
611077369 1295716850
HEALTHNET
—
05
—
7100148650
—
KY
Enumeration date
11/22/2010
Last updated
04/18/2012
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