Provider Demographics
NPI:1144093626
Name:SPIVEY, JESSICA KRISTINA (C-NP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KRISTINA
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:C-NP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 RUSSELLS MILLS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748-1222
Mailing Address - Country:US
Mailing Address - Phone:508-971-1802
Mailing Address - Fax:
Practice Address - Street 1:104 CHARLES ELDRIDGE RD STE 6
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-1388
Practice Address - Country:US
Practice Address - Phone:508-886-3921
Practice Address - Fax:508-644-0599
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2269941163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse