Provider Demographics
NPI:1366480220
Name:COLEMAN, BEVERLY CHARLIER (CPNP, RN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:CHARLIER
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:CPNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BULIFANTS BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5747
Mailing Address - Country:US
Mailing Address - Phone:757-564-7337
Mailing Address - Fax:
Practice Address - Street 1:119 BULIFANTS BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5709
Practice Address - Country:US
Practice Address - Phone:757-564-7337
Practice Address - Fax:757-564-3205
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024074650363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
71404NOtherSENTARA
VA010140960Medicaid