Provider Demographics
NPI:1043282502
Name:BRADSHAW, BEVERLY ANN (APRN BC)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:ANN
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-5062
Mailing Address - Country:US
Mailing Address - Phone:423-543-7919
Mailing Address - Fax:423-543-5323
Practice Address - Street 1:2521 BEECHWOOD DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-5062
Practice Address - Country:US
Practice Address - Phone:423-543-7919
Practice Address - Fax:423-543-5323
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49977363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3348271OtherMEDICARE PTAN
TN3348272OtherMECICARE PTAN
TN1043282502OtherNPI NUMBER
TN3348273OtherMEDICARE PTAN
TN3348273OtherMEDICARE PTAN