Provider Demographics
NPI:1902207301
Name:SPIVEY, LEEANN MCKENNA (APRN)
Entity Type:Individual
Prefix:
First Name:LEEANN
Middle Name:MCKENNA
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:502-864-1472
Mailing Address - Fax:270-858-4607
Practice Address - Street 1:512 SAFFELL ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1253
Practice Address - Country:US
Practice Address - Phone:502-839-1231
Practice Address - Fax:502-227-1114
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100319130Medicaid
KYK165030Medicare UPIN