Provider Demographics
NPI:1407941214
Name:CLARKE, BEVERLY SIMPLER (MSN, RN, CRN)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:SIMPLER
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MSN, RN, CRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8827 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-3405
Mailing Address - Country:US
Mailing Address - Phone:410-778-1869
Mailing Address - Fax:410-778-7086
Practice Address - Street 1:100 BROWN ST
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1435
Practice Address - Country:US
Practice Address - Phone:410-778-1420
Practice Address - Fax:410-778-7086
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR109133363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics