Provider Demographics
NPI:1588878813
Name:SPIVEY, BRIDGETT NICOLE (CPHT)
Entity type:Individual
Prefix:MRS
First Name:BRIDGETT
Middle Name:NICOLE
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 ABIFF RD
Mailing Address - Street 2:
Mailing Address - City:BON AQUA
Mailing Address - State:TN
Mailing Address - Zip Code:37025-5030
Mailing Address - Country:US
Mailing Address - Phone:615-347-5541
Mailing Address - Fax:615-446-9867
Practice Address - Street 1:758 HIGHWAY 46 S
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2556
Practice Address - Country:US
Practice Address - Phone:615-446-9865
Practice Address - Fax:615-446-9867
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000014102183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN210113123419661OtherCPHT