Provider Demographics
NPI:1194322719
Name:WOPART, SPENCER ELIJAH (APRN, CNP)
Entity type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:ELIJAH
Last Name:WOPART
Suffix:
Gender:M
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9311 S MINGO RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5702
Mailing Address - Country:US
Mailing Address - Phone:918-307-1613
Mailing Address - Fax:918-307-2454
Practice Address - Street 1:9311 S MINGO RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5702
Practice Address - Country:US
Practice Address - Phone:918-307-1613
Practice Address - Fax:918-307-2454
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK121897363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner