Provider Demographics
NPI:1578923371
Name:SPENCE, KRISTIN COX (APN, FNP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:COX
Last Name:SPENCE
Suffix:
Gender:F
Credentials:APN, FNP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ASHLEY
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN, FNP
Mailing Address - Street 1:4250 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-8737
Mailing Address - Country:US
Mailing Address - Phone:662-932-9111
Mailing Address - Fax:
Practice Address - Street 1:4250 BETHEL RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-8737
Practice Address - Country:US
Practice Address - Phone:662-932-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901471363LF0000X
TN21012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily