Provider Demographics
NPI:1275529430
Name:SMITH, BEVERLY A (FNP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W RIVER DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52801-1014
Mailing Address - Country:US
Mailing Address - Phone:563-336-3000
Mailing Address - Fax:563-336-3044
Practice Address - Street 1:500 W RIVER DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52801-1014
Practice Address - Country:US
Practice Address - Phone:563-336-3000
Practice Address - Fax:563-336-3044
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC030799363LP0200X
IL363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
S53434OtherUPIN
IA02874OtherIA BCBS SEEN IN DAVENPORT
IA42106072440OtherJOHN DEERE HEALTH
IAIA0140OtherJOHN DEERE EDI#
IA93327OtherIA BCBS SEEN IN MOLINE
IA93357OtherIA BCBS SEEN IN RI
079471OtherHEALTH ALLIANCE
IA5200098OtherCONTROLLED SUBSTANCE#
MS0159207OtherFEDERAL DEA#
IA93357OtherIA BCBS SEEN IN RI
079471OtherHEALTH ALLIANCE