Healthcare Provider Details

I. General information

NPI: 1104734623
Provider Name (Legal Business Name): SPENCER D MEEKS AGPCNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E WASHINGTON BLVD
FORT WAYNE IN
46802-3124
US

IV. Provider business mailing address

101 CABARRUS AVE E STE 20
CONCORD NC
28025-3699
US

V. Phone/Fax

Practice location:
  • Phone: 260-422-5511
  • Fax:
Mailing address:
  • Phone: 844-932-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71018580A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: