Provider Demographics
NPI:1770759730
Name:SPICER, CAROLE L (PA)
Entity type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:L
Last Name:SPICER
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:PO BOX 450
Mailing Address - Street 2:121 COURTHOUSE LANE
Mailing Address - City:BOWLING GREEN
Mailing Address - State:VA
Mailing Address - Zip Code:22427-0450
Mailing Address - Country:US
Mailing Address - Phone:804-633-5840
Mailing Address - Fax:804-633-4438
Practice Address - Street 1:121 COURTHOUSE LANE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:VA
Practice Address - Zip Code:22427
Practice Address - Country:US
Practice Address - Phone:804-633-5840
Practice Address - Fax:804-633-4438
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840334363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant