Healthcare Provider Details

I. General information

NPI: 1700545464
Provider Name (Legal Business Name): PATRICE SPENCER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 T B STANLEY HWY
BASSETT VA
24055-6108
US

IV. Provider business mailing address

1336 ROOT TRL
MARTINSVILLE VA
24112-5528
US

V. Phone/Fax

Practice location:
  • Phone: 276-638-0788
  • Fax:
Mailing address:
  • Phone: 276-634-7124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024183007
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: