Healthcare Provider Details

I. General information

NPI: 1588878813
Provider Name (Legal Business Name): BRIDGETT NICOLE SPIVEY CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 HIGHWAY 46 S
DICKSON TN
37055-2556
US

IV. Provider business mailing address

1248 ABIFF RD
BON AQUA TN
37025-5030
US

V. Phone/Fax

Practice location:
  • Phone: 615-446-9865
  • Fax: 615-446-9867
Mailing address:
  • Phone: 615-347-5541
  • Fax: 615-446-9867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0000014102
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: