Provider Demographics
NPI:1073829974
Name:GRAGG, BEVERLY A (RN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:GRAGG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 N KANSAS ST
Mailing Address - Street 2:SUITE #3054
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3124
Mailing Address - Country:US
Mailing Address - Phone:316-293-2622
Mailing Address - Fax:316-630-0373
Practice Address - Street 1:9300 E 29TH ST N
Practice Address - Street 2:SUITE #209
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2182
Practice Address - Country:US
Practice Address - Phone:316-293-2622
Practice Address - Fax:316-630-0373
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-88755-012163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse