Provider Demographics
NPI:1699587105
Name:SPENCE, ALEXIAH (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXIAH
Middle Name:
Last Name:SPENCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10315 E SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:IN
Mailing Address - Zip Code:47383-9404
Mailing Address - Country:US
Mailing Address - Phone:765-749-9051
Mailing Address - Fax:
Practice Address - Street 1:10315 E SUNSET DR
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:IN
Practice Address - Zip Code:47383-9404
Practice Address - Country:US
Practice Address - Phone:765-749-9051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant