Provider Demographics
NPI:1679670202
Name:DEVINE, BETH A (APRN)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:A
Last Name:DEVINE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:A
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 9150
Mailing Address - Street 2:REGIONAL HEALTH CARE AFFILIATES
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-667-7017
Mailing Address - Fax:270-667-9065
Practice Address - Street 1:215 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:KY
Practice Address - Zip Code:42450-1261
Practice Address - Country:US
Practice Address - Phone:270-667-7017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4408P363LF0000X
KY3004408363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4408POtherLICENSE
000000351079OtherBCBS PROVIDER NUMBER
KY78013083Medicaid
0935306Medicare PIN
0903656Medicare PIN
KYP00206949Medicare PIN
000000351079OtherBCBS PROVIDER NUMBER
Q26888Medicare UPIN
0952004Medicare PIN