Provider Demographics
NPI:1417787375
Name:SPENCER, MIRANDI RAE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:MIRANDI
Middle Name:RAE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 HIGHWAY 3048
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-3624
Mailing Address - Country:US
Mailing Address - Phone:318-728-8322
Mailing Address - Fax:
Practice Address - Street 1:254 HIGHWAY 3048
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-3624
Practice Address - Country:US
Practice Address - Phone:318-728-8322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA236650363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care