MEDICARE: DR. DUSTIN SPENCER DNP, FNP-C, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	116590	NE
2	363LF0000X	Family Nurse Practitioner	0024178379	VA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2361264	MA
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	14262996-4405	UT
5	363LF0000X	Family Nurse Practitioner	20187	SC
6	363LF0000X	Family Nurse Practitioner	4704252348	MI
7	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024178379	VA
8	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	L8-0010312	DE
9	363L00000X	Nurse Practitioner	5013569	NC
10	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704252348	MI
11	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	20187	SC

General Provider Information

NPI Number	:	1083930663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUSTIN SPENCER DNP, FNP-C, PMHNP-BC

Provider Business Mailing Address
First Line	:	2764 PLEASANT RD STE A-10701
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-7213
Country	:	US
Telephone Number	:	803-906-0952
Fax Number	:	681-662-2733

Provider Business Practice Location Address
First Line	:	2764 PLEASANT RD STE A-10701
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-7213
Country	:	US
Telephone Number	:	803-906-0952
Fax Number	:	681-662-2733

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

Provider Enumeration Date	:	04/08/2010
Last Update Date	:	03/25/2026

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