Provider Demographics
NPI:1578515516
Name:BEAVER, VERNON R (CRNA)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:R
Last Name:BEAVER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2715
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602-2715
Mailing Address - Country:US
Mailing Address - Phone:256-353-0826
Mailing Address - Fax:256-350-2609
Practice Address - Street 1:750 MORPHY AVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1812
Practice Address - Country:US
Practice Address - Phone:251-990-1109
Practice Address - Fax:251-990-1112
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-033685367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR81712Medicare UPIN
AL051514801Medicare ID - Type Unspecified