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KIMYUATTA A SPENCER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RPT

Contact information

Practice address
216 1ST ST S, REFORM, AL 35481
(205) 375-9255
(205) 375-9245
Mailing address
11118 ALFORD AVE, NORTHPORT, AL 35475-4530
(205) 330-8526

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
PTH3586
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
51532337
BCBS PROVIDER NUMBER
AL
01
PTH3586
LICENSURE NUMBER
AL
Enumeration date
04/20/2007
Last updated
07/08/2007
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