Healthcare Provider Details

I. General information

NPI: 1821827007
Provider Name (Legal Business Name): AMBER LASHAE SPENCER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 HILLS PLZ
CHARLESTON WV
25387-2438
US

IV. Provider business mailing address

220 RED MULBERRY WAY APT 5
CHARLESTON WV
25306-6320
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-4466
  • Fax:
Mailing address:
  • Phone: 304-410-6207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11716
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: