Provider Demographics
NPI:1275634214
Name:MCCANN, BEVERLY D (FNP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:D
Last Name:MCCANN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:D
Other - Last Name:FERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERN
Mailing Address - State:TN
Mailing Address - Zip Code:38059-1214
Mailing Address - Country:US
Mailing Address - Phone:731-627-0734
Mailing Address - Fax:
Practice Address - Street 1:105 N MONROE ST
Practice Address - Street 2:
Practice Address - City:NEWBERN
Practice Address - State:TN
Practice Address - Zip Code:38059-1214
Practice Address - Country:US
Practice Address - Phone:731-627-0734
Practice Address - Fax:731-627-0736
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005297363LF0000X
TNAPN5297363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4109106OtherBCBS
TN3343307Medicaid
TNS28337Medicare UPIN
TN3343307Medicaid