Provider Demographics
NPI:1619490794
Name:STEPHENSON, BEVERLY (FNP-C)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:AYCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1511 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:CANADIAN
Mailing Address - State:TX
Mailing Address - Zip Code:79014-3509
Mailing Address - Country:US
Mailing Address - Phone:806-679-8733
Mailing Address - Fax:
Practice Address - Street 1:1010 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CANADIAN
Practice Address - State:TX
Practice Address - Zip Code:79014-3315
Practice Address - Country:US
Practice Address - Phone:806-323-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily