Provider Demographics
NPI:1790321552
Name:SPIVEY, REBECCA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 HIGHWAY 153 STE 105
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3702
Mailing Address - Country:US
Mailing Address - Phone:423-468-1372
Mailing Address - Fax:
Practice Address - Street 1:5441 HIGHWAY 153 STE 105
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3702
Practice Address - Country:US
Practice Address - Phone:423-468-1372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26860363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner