Provider Demographics
NPI:1205259561
Name:OSBORNE-SPENCER, MICHELLE ANN (PA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:OSBORNE-SPENCER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ANN
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:701 S FRY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2255
Mailing Address - Country:US
Mailing Address - Phone:281-398-4222
Mailing Address - Fax:281-398-4001
Practice Address - Street 1:701 S FRY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2255
Practice Address - Country:US
Practice Address - Phone:281-398-4222
Practice Address - Fax:281-398-4001
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01752363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical