Provider Demographics
NPI:1538932959
Name:SPEAR, MACKENZIE PAYTON JO (APRN)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:PAYTON JO
Last Name:SPEAR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 NUTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-4927
Mailing Address - Country:US
Mailing Address - Phone:270-535-1342
Mailing Address - Fax:
Practice Address - Street 1:5872 SCOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-7853
Practice Address - Country:US
Practice Address - Phone:270-746-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4010378207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine