Provider Demographics
NPI:1235939133
Name:SPENCER, PAZELY RACHELLE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:PAZELY
Middle Name:RACHELLE
Last Name:SPENCER
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:PAZELY
Other - Middle Name:RACHELLE
Other - Last Name:YATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:180 NW BRENT CT
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6000
Mailing Address - Country:US
Mailing Address - Phone:360-355-5742
Mailing Address - Fax:
Practice Address - Street 1:11 SW BRANTLEY DR
Practice Address - Street 2:
Practice Address - City:WINSTON
Practice Address - State:OR
Practice Address - Zip Code:97496-4526
Practice Address - Country:US
Practice Address - Phone:541-679-0366
Practice Address - Fax:541-679-4821
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10041902363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty