MEDICARE: MRS. STEPHANIE SPENCER FNP-C

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	363LF0000X	Family Nurse Practitioner	1226611	TX

General Provider Information

NPI Number	:	1336005289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE SPENCER FNP-C

Provider Business Mailing Address
First Line	:	4015 I 45 N
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-5074
Country	:	US
Telephone Number	:	936-441-1122
Fax Number	:

Provider Business Practice Location Address
First Line	:	4015 I 45 N STE 220
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-5076
Country	:	US
Telephone Number	:	936-441-1122
Fax Number	:

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

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	02/17/2026

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