Kimyuatta A Spencer, RPT

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

PTH3586 Issued in AL

Practice address

216 1St St S
Reform, AL 35481

Phone

(205) 375-9255

Fax

(205) 375-9245

NPI assigned

Apr 20, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Amedisys Alabama, LLC

  dba Amedisys Home Health of Reform

  • Home Health Agency
  • Carrollton, AL
  • NPI 1326006628
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760600308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11118 ALFORD AVE",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354754530",
            "telephone_number": "205-330-8526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 1ST ST S",
            "city": "REFORM",
            "state": "AL",
            "postal_code": "35481",
            "telephone_number": "205-375-9255",
            "fax_number": "205-375-9245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "KIMYUATTA",
        "middle_name": "A",
        "credential": "RPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "AL",
            "license": "PTH3586",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "51532337",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSURE NUMBER",
            "identifier": "PTH3586",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Harry Lee Richardson Jr., MD
• Brenda Sue Robertson
• Robrich Enterprise LLC (Robertson Medical)
• Salem Nursing & Rehab Center of Reform, Inc. (Salem Nursing & Rehab of Reform)
• Erin Simpson Shirley, FNP-C
• Marcus Stephenson, CRNP
• Deanna S Wilkins, LPC

• Home Health Agency in Reform, AL
• Providers in Reform, AL by specialty
• Home Health Agency in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.