Provider Demographics
NPI:1598252223
Name:BEVERLY, CYNTHIA M (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:M
Last Name:BEVERLY
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 1:208 RUE LOUIS XIV
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5737
Mailing Address - Country:US
Mailing Address - Phone:337-504-5885
Mailing Address - Fax:337-227-6203
Practice Address - Street 1:208 RUE LOUIS XIV
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5737
Practice Address - Country:US
Practice Address - Phone:337-504-5885
Practice Address - Fax:337-227-6203
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP09808OtherSTATE BOARD OF NURSING
LA2475037Medicaid