Provider Demographics
NPI:1629547526
Name:SPENCER, TAMEKIA
Entity Type:Individual
Prefix:
First Name:TAMEKIA
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMEKIA
Other - Middle Name:NICOLE
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70707-0359
Mailing Address - Country:US
Mailing Address - Phone:225-242-7841
Mailing Address - Fax:866-234-8190
Practice Address - Street 1:108 E SANDERS ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-3144
Practice Address - Country:US
Practice Address - Phone:225-647-4105
Practice Address - Fax:866-234-8190
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator