Provider Demographics
NPI:1376908194
Name:WILSON, BEVERLY BELK (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:BELK
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 COUNTY COMPLEX RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-4846
Mailing Address - Country:US
Mailing Address - Phone:615-585-6699
Mailing Address - Fax:
Practice Address - Street 1:360 COUNTY COMPLEX RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-4845
Practice Address - Country:US
Practice Address - Phone:615-585-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008343363LF0000X
TN20005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily