Provider Demographics
NPI:1518167949
Name:SPIERS, SANDRA JANELL (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JANELL
Last Name:SPIERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WOODMONT DR
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-7658
Mailing Address - Country:US
Mailing Address - Phone:601-347-3029
Mailing Address - Fax:
Practice Address - Street 1:117 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3936
Practice Address - Country:US
Practice Address - Phone:769-242-0896
Practice Address - Fax:769-242-0896
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
LAAP06825363LP0808X
MSR836775363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1107468Medicaid
2831390OtherUHC
MSP00816371OtherRAILROAD MEDICARE
MS04778509Medicaid
LA3D162DV13Medicare PIN
MS512I500067Medicare PIN