Provider Demographics
NPI:1073877692
Name:SPIVEY, KRISTIE MICHELLE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:MICHELLE
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:MICHELLE
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7351 OLD MOON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-7291
Mailing Address - Country:US
Mailing Address - Phone:706-653-7000
Mailing Address - Fax:706-653-7800
Practice Address - Street 1:7351 OLD MOON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-7291
Practice Address - Country:US
Practice Address - Phone:706-653-7000
Practice Address - Fax:706-653-7800
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN163543363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner