Provider Demographics
NPI:1538935838
Name:SPENCE, KADIAN
Entity type:Individual
Prefix:
First Name:KADIAN
Middle Name:
Last Name:SPENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 ALLENDALE RD UNIT 80678
Mailing Address - Street 2:
Mailing Address - City:VALLEY FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:19484-0039
Mailing Address - Country:US
Mailing Address - Phone:484-250-9456
Mailing Address - Fax:
Practice Address - Street 1:620 ALLENDALE RD UNIT 80678
Practice Address - Street 2:
Practice Address - City:VALLEY FORGE
Practice Address - State:PA
Practice Address - Zip Code:19484-0039
Practice Address - Country:US
Practice Address - Phone:484-250-9456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN673967363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health