Provider Demographics
NPI:1427876259
Name:SPIVEY, RACHEL ELYSE (CPNP-AC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELYSE
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ELYSE
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 933421
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0039
Mailing Address - Country:US
Mailing Address - Phone:937-641-5072
Mailing Address - Fax:937-641-6129
Practice Address - Street 1:3333 W TECH RD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-0955
Practice Address - Country:US
Practice Address - Phone:937-641-5725
Practice Address - Fax:937-350-3050
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0037365363LP0200X
OHRN.374677163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0085023Medicaid