MEDICARE: MICHELLE SPENCER FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2015025652	MO

General Provider Information

NPI Number	:	1003282864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE SPENCER FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 802843
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-2843
Country	:	US
Telephone Number	:	417-730-6430
Fax Number	:	417-269-7567

Provider Business Practice Location Address
First Line	:	2750 S CAMPBELL AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-3506
Country	:	US
Telephone Number	:	417-269-2281
Fax Number	:	417-269-2292

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	04/12/2023

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