Provider Demographics
NPI:1558141606
Name:LIFE REIMAGINED LLC
Entity Type:Organization
Organization Name:LIFE REIMAGINED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:931-345-3968
Mailing Address - Street 1:5247 VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-7179
Mailing Address - Country:US
Mailing Address - Phone:931-345-3968
Mailing Address - Fax:931-208-3484
Practice Address - Street 1:3380 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-5365
Practice Address - Country:US
Practice Address - Phone:931-345-3968
Practice Address - Fax:931-208-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty