MEDICARE: MIRANDA KAYE SPENCER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency		MI

General Provider Information

NPI Number	:	1063340198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA KAYE SPENCER

Provider Business Mailing Address
First Line	:	710 S BROWN ST STE 1
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-1429
Country	:	US
Telephone Number	:	517-759-5022
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 S BROWN ST STE 1
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-1429
Country	:	US
Telephone Number	:	517-759-5022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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Directions to “ MIRANDA KAYE SPENCER ” Practice Location

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