Healthcare Provider Details

I. General information

NPI: 1578024147
Provider Name (Legal Business Name): MEREDITH ANNE SPENCER APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 HICKORY CREEK LN
ROCKWALL TX
75032-7335
US

IV. Provider business mailing address

1489 HICKORY CREEK LN
ROCKWALL TX
75032-7335
US

V. Phone/Fax

Practice location:
  • Phone: 337-802-4887
  • Fax:
Mailing address:
  • Phone: 337-802-4887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP141137
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP141137
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: