Provider Demographics
NPI:1538552120
Name:SPECTER, TRISHA L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:L
Last Name:SPECTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:TRISHA
Other - Middle Name:L
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:520 S ELM AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3845
Mailing Address - Country:US
Mailing Address - Phone:314-645-4434
Mailing Address - Fax:314-645-3801
Practice Address - Street 1:520 S ELM AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-3845
Practice Address - Country:US
Practice Address - Phone:314-645-4434
Practice Address - Fax:314-645-3801
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015006779363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2015006779OtherSTATE LICENSE