Provider Demographics
NPI:1023444551
Name:SPENCER, KRISTAL LARE (FNP)
Entity type:Individual
Prefix:
First Name:KRISTAL
Middle Name:LARE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:719 W COKE RD STE 6
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-3060
Practice Address - Country:US
Practice Address - Phone:903-342-3760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX702355363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FD920OtherBCBS
TXP01569955OtherRAIL ROAD MEDICARE
TX352751701Medicaid
TX75-2616977-029OtherTRICARE
TX75-2771569-005OtherTRICARE
TX8349NQOtherBCBS
TX75-2616977-066OtherTRICARE
TXP01511483OtherRAIL ROAD MEDICARE
TX75-2616977-121OtherTRICARE
TX75-2616977-023OtherTRICARE
TX352751702Medicaid
TX352751701Medicaid
TX75-2616977-066OtherTRICARE