Provider Demographics
NPI:1295019883
Name:SKINNER-WELLS, BEVERLY (ARDMS/RVT)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:SKINNER-WELLS
Suffix:
Gender:F
Credentials:ARDMS/RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 E LAKE DR
Mailing Address - Street 2:
Mailing Address - City:GLADEWATER
Mailing Address - State:TX
Mailing Address - Zip Code:75647-9205
Mailing Address - Country:US
Mailing Address - Phone:903-399-0858
Mailing Address - Fax:877-879-7379
Practice Address - Street 1:1408 E LAKE DR
Practice Address - Street 2:
Practice Address - City:GLADEWATER
Practice Address - State:TX
Practice Address - Zip Code:75647-9205
Practice Address - Country:US
Practice Address - Phone:903-399-0858
Practice Address - Fax:877-879-7379
Is Sole Proprietor?:No
Enumeration Date:2011-10-01
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11039246XS1301X, 2471S1302X, 246XC2903X, 2471V0105X, 2471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular Specialist
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11039OtherARDMS-RVT