Provider Demographics
NPI:1932674231
Name:SPENCER, REBECCA J (FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:SPENCER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYDIA-MARIE
Other - Last Name:PRIEWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REBECCA JAYNE ASHTON
Mailing Address - Street 1:2062 COMAL SPGS
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:78133-5981
Mailing Address - Country:US
Mailing Address - Phone:210-834-3072
Mailing Address - Fax:
Practice Address - Street 1:952 GRUENE RD
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3920
Practice Address - Country:US
Practice Address - Phone:830-326-7013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX391160403OtherCSHCN
TX391160402Medicaid