MEDICARE: STACY SPENCER NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	71011262A	IN

General Provider Information

NPI Number	:	1952985632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY SPENCER NP

Provider Business Mailing Address
First Line	:	PO BOX 775383
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-5383
Country	:	US
Telephone Number	:	812-376-5315
Fax Number	:

Provider Business Practice Location Address
First Line	:	2118 25TH ST STE E
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-3240
Country	:	US
Telephone Number	:	812-373-2700
Fax Number	:	812-373-2720

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

Provider Enumeration Date	:	05/10/2021
Last Update Date	:	02/24/2026

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