Provider Demographics
NPI:1659382877
Name:PHIPPS, BEVERLY (CRNS)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:CRNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 PARK MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081
Mailing Address - Country:US
Mailing Address - Phone:614-882-9338
Mailing Address - Fax:614-882-3401
Practice Address - Street 1:774 PARK MEADOW RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081
Practice Address - Country:US
Practice Address - Phone:614-882-9338
Practice Address - Fax:614-882-3401
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS01575163W00000X
OHNS00771364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNS00771Medicare ID - Type Unspecified