Provider Demographics
NPI:1992716278
Name:SPIVEY, LEIGH V (ACNP)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:V
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21327
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-1327
Mailing Address - Country:US
Mailing Address - Phone:254-399-5400
Mailing Address - Fax:254-772-8669
Practice Address - Street 1:7125 NEW SANGER AVENUE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710
Practice Address - Country:US
Practice Address - Phone:254-399-5400
Practice Address - Fax:254-772-8669
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX600778363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y1514OtherBLUE CROSS BLUE SHIELD
TXQ60634Medicare UPIN
TX8G5650Medicare PIN
P00376370Medicare PIN