Provider Demographics
NPI:1043596828
Name:MCKEAN, BEVERLY SUE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:SUE
Last Name:MCKEAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3413
Mailing Address - Country:US
Mailing Address - Phone:386-675-5274
Mailing Address - Fax:
Practice Address - Street 1:809 GROVE AVE
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-3413
Practice Address - Country:US
Practice Address - Phone:386-675-5274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9257416163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice