Basic Information
| Provider Information | |||||||||
| NPI: | 1669862801 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPENCER | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4204 HOUMA BLVD | ||||||||
| Address2: | FL 2 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700062903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048832968 | ||||||||
| FaxNumber: | 5048832973 | ||||||||
| Practice Location | |||||||||
| Address1: | 4204 HOUMA BLVD | ||||||||
| Address2: | FL 2 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700062903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048832968 | ||||||||
| FaxNumber: | 5048832973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2015 | ||||||||
| LastUpdateDate: | 01/05/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP08024 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 2386697 | 05 | LA | MEDICAID |