Provider Demographics
NPI:1932096989
Name:SPENCER, MAGAN LEANN (APRN-FNP-C)
Entity type:Individual
Prefix:
First Name:MAGAN
Middle Name:LEANN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:APRN-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75653-0224
Mailing Address - Country:US
Mailing Address - Phone:903-316-6116
Mailing Address - Fax:
Practice Address - Street 1:700 OLYMPIC PLAZA CIR STE 410
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1952
Practice Address - Country:US
Practice Address - Phone:903-596-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX743695363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner