Provider Demographics
NPI:1538168398
Name:SPENCER, LEIGH WINTER (NP)
Entity type:Individual
Prefix:MS
First Name:LEIGH
Middle Name:WINTER
Last Name:SPENCER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 BELK BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5301
Mailing Address - Country:US
Mailing Address - Phone:662-236-4675
Mailing Address - Fax:662-281-0819
Practice Address - Street 1:1397 BELK BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5301
Practice Address - Country:US
Practice Address - Phone:662-236-4675
Practice Address - Fax:662-281-0819
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN139992363LF0000X
MSR890697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA225713508CMedicaid
GA225713508BMedicaid
GA225713508FMedicaid