Healthcare Provider Details

I. General information

NPI: 1083930663
Provider Name (Legal Business Name): DUSTIN SPENCER DNP, FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2764 PLEASANT RD STE A-10701
FORT MILL SC
29708-7213
US

IV. Provider business mailing address

2764 PLEASANT RD STE A-10701
FORT MILL SC
29708-7213
US

V. Phone/Fax

Practice location:
  • Phone: 803-906-0952
  • Fax: 681-662-2733
Mailing address:
  • Phone: 803-906-0952
  • Fax: 681-662-2733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number116590
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178379
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2361264
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14262996-4405
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20187
License Number StateSC
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704252348
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024178379
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0010312
License Number StateDE
# 9
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5013569
License Number StateNC
# 10
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704252348
License Number StateMI
# 11
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number20187
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: