Healthcare Provider Details

I. General information

NPI: 1396920419
Provider Name (Legal Business Name): KIMBERLY ANNETTE SPIVEY FPMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 WALNUT GROVE RD
SPARTA TN
38583-5365
US

IV. Provider business mailing address

105 CHERRY AVE
COOKEVILLE TN
38501
US

V. Phone/Fax

Practice location:
  • Phone: 931-345-3968
  • Fax: 931-208-3484
Mailing address:
  • Phone: 931-528-5811
  • Fax: 931-526-1497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN13410
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: