Provider Demographics
NPI:1548291230
Name:SPENCER, AUDREY (MD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:AUDREY
Other - Middle Name:S
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:910 KENTON STATION DRIVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056
Mailing Address - Country:US
Mailing Address - Phone:606-759-0706
Mailing Address - Fax:606-393-0185
Practice Address - Street 1:910 KENTON STATION RD
Practice Address - Street 2:SUITE D
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-9658
Practice Address - Country:US
Practice Address - Phone:606-759-0706
Practice Address - Fax:606-759-8117
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY19I8OtherANTHEM BC/BS KY
KY64231558Medicaid
OH6A11OtherANTHEM BC/BS OH
C02578Medicare UPIN
KY64231558Medicaid