Provider Demographics
NPI:1205376167
Name:SPENCER, MEREDITH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HICKOK ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3569
Mailing Address - Country:US
Mailing Address - Phone:540-381-1882
Mailing Address - Fax:
Practice Address - Street 1:614 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1818
Practice Address - Country:US
Practice Address - Phone:540-731-1600
Practice Address - Fax:540-772-3444
Is Sole Proprietor?:No
Enumeration Date:2017-02-26
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174610363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner