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NPI Code Detail

MEDICARE: JAMIE SPENCER NP-C

MEDICARE: JAMIE SPENCER NP-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
1363LF0000XFamily Nurse PractitionerAPRN56052WV

General Provider Information

NPI Number : 1083056345
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE SPENCER NP-C
Provider Business Mailing Address
First Line : 33 WALKER RD
Second Line :
City : SOUTH CHARLESTON
State : WV
Zip : 25309-9237
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4619 KANAWHA AVE SW
Second Line :
City : SOUTH CHARLESTON
State : WV
Zip : 25309-1319
Country : US
Telephone Number : 304-400-4545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2013
Last Update Date : 03/08/2018

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