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General NPI Number Information
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NPI Number | 1104197508
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Entity Type | Individual
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Provider Name | REGAN DOLEAC SPENCE NP-C
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Gender | Female
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 350 WEST WOODROW WILSON
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City | JACKSON
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State | MS
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Zip | 39213
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Country | US
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Telephone | 601-815-0115
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Fax | 601-984-5257
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Provider Business Mailing Address
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Address Line | 2500 NORTH STATE STREET
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City | JACKSON
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State | MS
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Zip | 39216
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Country | US
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Telephone | 601-815-0115
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Fax | 601-984-5257
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R865925
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License Number State | MS
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