Active NPI
Broxann Spencer, MD
- Psychiatry Physician
- N Charleston, SC
National Provider Identifier
1992897532
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 17568
- Practice address
- 3601 Meeting Street Rd # C
N Charleston, SC 29405-7715 - Phone
- (843) 740-6136
- NPI assigned
- Sep 29, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 17568 | SC | Primary |
Addresses
Primary practice location
3601 Meeting Street Rd # C
N Charleston, SC 29405-7715
Mailing address
3601 Meeting Street Rd # C
N Charleston, SC 29405-7715
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 190166 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17568 | SC | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992897532",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3601 MEETING STREET RD # C",
"city": "N CHARLESTON",
"state": "SC",
"postal_code": "294057715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3601 MEETING STREET RD # C",
"city": "N CHARLESTON",
"state": "SC",
"postal_code": "294057715",
"telephone_number": "843-740-6136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPENCER",
"first_name": "BROXANN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "SC",
"license": "17568",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "190166",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in N Charleston, SC
- South Carolina Sports Medicine & Orthopaedic Center
- South Coast Gastroenterology
- Southern Oak Dental, LLC
- Savannah Marie Spearman, FNP-BC
- Specialized Alternative for Families and Youth of South Carolina, Inc.
- Sports Plus
- Phillip Steele, LMT
- Jasmine Samone Stowers
- Supplemental Health Care
- Stephen Tanner
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.