Provider Demographics
NPI:1790060853
Name:SPIVEY, SARA RENEE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:RENEE
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 1:207 W. HALL
Mailing Address - Street 2:
Mailing Address - City:BANGS
Mailing Address - State:TX
Mailing Address - Zip Code:76823
Mailing Address - Country:US
Mailing Address - Phone:325-752-6521
Mailing Address - Fax:
Practice Address - Street 1:207 WEST HALL
Practice Address - Street 2:
Practice Address - City:BANGS
Practice Address - State:TX
Practice Address - Zip Code:76823
Practice Address - Country:US
Practice Address - Phone:325-752-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120981363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily