Provider Demographics
NPI:1407839749
Name:GOODWIN, BEVERLY BECK (FNP, RN)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:BECK
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HEATHER CT
Mailing Address - Street 2:
Mailing Address - City:GIBSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27249-2753
Mailing Address - Country:US
Mailing Address - Phone:336-449-5338
Mailing Address - Fax:
Practice Address - Street 1:2040 CAMPUS BOX
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-2010
Practice Address - Country:US
Practice Address - Phone:336-278-7230
Practice Address - Fax:336-538-6506
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily