Provider Demographics
NPI:1659330215
Name:REEVES-DUDLEY, BEVERLY (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:REEVES-DUDLEY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8118 GOODMAN ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-3502
Mailing Address - Country:US
Mailing Address - Phone:913-642-4231
Mailing Address - Fax:
Practice Address - Street 1:10965 GRANADA LN
Practice Address - Street 2:STE. 102
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1469
Practice Address - Country:US
Practice Address - Phone:913-663-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS75836363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO430043228Medicare PIN
MO452000005Medicare PIN
MOOTH000Medicare UPIN
MO913800009Medicaid