Provider Demographics
NPI:1861845190
Name:SPENCE, JAMIE (APRN - CNS)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:SPENCE
Suffix:
Gender:F
Credentials:APRN - CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 12TH AVE NW STE B
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1206
Mailing Address - Country:US
Mailing Address - Phone:580-223-5180
Mailing Address - Fax:580-223-5184
Practice Address - Street 1:731 12TH AVE NW STE 302
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5765
Practice Address - Country:US
Practice Address - Phone:580-220-6200
Practice Address - Fax:580-220-6258
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK72205364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health