Provider Demographics
NPI:1144551029
Name:SPENCER, LAUREN M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:M
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:LAUREN
Other - Middle Name:M
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 4930
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74159-0930
Mailing Address - Country:US
Mailing Address - Phone:918-747-4975
Mailing Address - Fax:918-743-8552
Practice Address - Street 1:5801 E 41ST ST STE 900
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5631
Practice Address - Country:US
Practice Address - Phone:918-747-4975
Practice Address - Fax:918-743-8552
Is Sole Proprietor?:No
Enumeration Date:2010-01-16
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1864363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKA103787Medicare PIN