Provider Demographics
NPI:1598883910
Name:WRIGHT, BEVERLY LOCKE (CNM, MSN, ARNP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:LOCKE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:CNM, MSN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-2853
Mailing Address - Country:US
Mailing Address - Phone:360-330-2899
Mailing Address - Fax:360-330-5791
Practice Address - Street 1:1020 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-2853
Practice Address - Country:US
Practice Address - Phone:360-330-2899
Practice Address - Fax:360-330-5791
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003909367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9630799Medicaid