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General NPI Number Information
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NPI Number | 1558141606
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Entity Type | Organization
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Legal Business Name | LIFE REIMAGINED LLC
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Dates
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Enumeration Date | 10/04/2023
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 3380 WALNUT GROVE RD
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City | SPARTA
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State | TN
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Zip | 38583-5365
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Country | US
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Telephone | 931-345-3968
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Fax | 931-208-3484
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Provider Business Mailing Address
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Address Line | 5247 VILLAGE RD
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City | COOKEVILLE
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State | TN
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Zip | 38506-7179
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Country | US
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Telephone | 931-345-3968
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Fax | 931-208-3484
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY A SPIVEY
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Credential | FNP
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Telephone | 931-345-3968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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