Provider Demographics
NPI:1629423181
Name:NESBIT, BEVERLY (MA, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:NESBIT
Suffix:
Gender:F
Credentials:MA, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 FRIENDSHIP CIR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3906
Mailing Address - Country:US
Mailing Address - Phone:336-758-4272
Mailing Address - Fax:
Practice Address - Street 1:1834 WAKE FOREST RD
Practice Address - Street 2:1158 WORRELL PROFESSIONAL CENTER
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27109-6000
Practice Address - Country:US
Practice Address - Phone:336-758-4272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLDN00954133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered