Provider Demographics
NPI:1760966337
Name:SPENCER, MISTY (MSN, APRN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11850 HASTINGS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-6276
Mailing Address - Country:US
Mailing Address - Phone:770-603-4745
Mailing Address - Fax:
Practice Address - Street 1:11850 HASTINGS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-6276
Practice Address - Country:US
Practice Address - Phone:770-603-4745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA185131363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily