Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Spencer Waller, FNP

Individual provider Nurse Practitioner · NPI 1033629241

Mr. Spencer Waller, FNP is a Nurse Practitioner in Pueblo, Colorado. Qualified in 2017, 9 years ago. Practices with Southern Colorado Emergency Medical Associates, a 26-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Colorado.

Years since qualifying
9
Licensed in
CO
In the registry since
2017
What do these letters mean?
FNP — Family Nurse Practitioner
A nurse practitioner who treats patients of all ages, much like a family doctor.

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Practice location Address checks out

400 W 16th St
Pueblo, CO 81003-2781
Phone: (719) 584-4306
Fax: (719) 595-7886
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1619 N Greenwood St Ste 309, Pueblo, CO 81003-2657 — (719) 544-7115

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence ANP.0993430-NP (CO)

Record details

NPI number1033629241
Entity typeIndividual (Type 1)
GenderMale
Credentials FNP
Sole proprietorYes
NPI enumeratedOctober 3, 2017
Last updated in NPPESMarch 29, 2018

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Southern Colorado Emergency Medical Associates — 26 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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