Provider Demographics
NPI:1306233176
Name:SPENCER, AMANDA (APRN CNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:APRN CNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4050 W MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8382
Mailing Address - Country:US
Mailing Address - Phone:405-608-3800
Mailing Address - Fax:405-680-3838
Practice Address - Street 1:4050 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8382
Practice Address - Country:US
Practice Address - Phone:405-608-3800
Practice Address - Fax:405-680-3838
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK96251363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200588340AMedicaid
OK419878YMU8Medicare PIN
OK200588340AMedicaid