Provider Demographics
NPI:1619754199
Name:BEEVERS, CALLIE VICTORIA (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:VICTORIA
Last Name:BEEVERS
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3118 ROCKY MEADOWS RD SE
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-8799
Mailing Address - Country:US
Mailing Address - Phone:256-348-3942
Mailing Address - Fax:
Practice Address - Street 1:612 MADISON ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4401
Practice Address - Country:US
Practice Address - Phone:256-763-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-173544363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health