Provider Demographics
NPI:1083930663
Name:SPENCER, DUSTIN (DNP, FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:
Last Name:SPENCER
Suffix:
Gender:M
Credentials:DNP, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2764 PLEASANT RD STE A-10701
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7213
Mailing Address - Country:US
Mailing Address - Phone:803-906-0952
Mailing Address - Fax:681-662-2733
Practice Address - Street 1:2764 PLEASANT RD STE A-10701
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7213
Practice Address - Country:US
Practice Address - Phone:803-906-0952
Practice Address - Fax:681-662-2733
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013569363L00000X
VA0024178379363LF0000X, 363LP0808X
SC20187363LF0000X, 363LP0808X
MI4704252348363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN11800010Medicare UPIN