Provider Demographics
NPI:1396920419
Name:SPIVEY, KIMBERLY ANNETTE (FPMHNP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANNETTE
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:FPMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501
Mailing Address - Country:US
Mailing Address - Phone:931-528-5811
Mailing Address - Fax:931-526-1497
Practice Address - Street 1:105 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2521
Practice Address - Country:US
Practice Address - Phone:931-528-5811
Practice Address - Fax:931-526-1497
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN13410363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health