Healthcare Provider Details

I. General information

NPI: 1255297107
Provider Name (Legal Business Name): KIMBERLY REENAY SPIVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12101 APACHE TEARS CIR
LAUREL MD
20708-2863
US

IV. Provider business mailing address

12101 APACHE TEARS CIR
LAUREL MD
20708-2863
US

V. Phone/Fax

Practice location:
  • Phone: 240-380-5181
  • Fax:
Mailing address:
  • Phone: 240-380-5181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberMT0182209
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMTO82209
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: