Individual
ELYSE A. SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7044 LEBANON RD, SUITE 102, FRISCO, TX 75034-7458
(936) 828-6644
(972) 712-5113
Mailing address
7044 LEBANON RD, SUITE 102, FRISCO, TX 75034-7458
(936) 828-6644
(972) 712-5113
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA04705
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8N9949
BLUE SHIELD
TX
Enumeration date
04/08/2006
Last updated
09/23/2011
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