Provider Demographics
NPI:1710456629
Name:SPIVEY, LISA (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:CASTLE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1822
Mailing Address - Country:US
Mailing Address - Phone:210-341-1487
Mailing Address - Fax:
Practice Address - Street 1:6915 WEST AVE
Practice Address - Street 2:
Practice Address - City:CASTLE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78213-1822
Practice Address - Country:US
Practice Address - Phone:210-341-1487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF10181809363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner