Provider Demographics
NPI:1811383631
Name:SPENCER, BRANDI LOUISE (PA)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:LOUISE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 N GARRETT AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-7514
Mailing Address - Country:US
Mailing Address - Phone:214-827-6880
Mailing Address - Fax:214-827-0520
Practice Address - Street 1:1717 N GARRETT AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-7514
Practice Address - Country:US
Practice Address - Phone:214-827-6880
Practice Address - Fax:214-827-0520
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09461363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant