Basic Information
| Provider Information | |||||||||
| NPI: | 1467185561 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIDSON | ||||||||
| FirstName: | SPENCER | ||||||||
| MiddleName: | WOOD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5314 W 71ST TER | ||||||||
| Address2: | |||||||||
| City: | PRAIRIE VILLAGE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662082335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4175290069 | ||||||||
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| Practice Location | |||||||||
| Address1: | KU HEALTH SYSTEM 4000 CAMBRIDGE STREET | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135881227 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2022 | ||||||||
| LastUpdateDate: | 07/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 43-5579-79-121 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.