Provider Demographics
NPI:1689762122
Name:DRISKILL, BEVERLY A (APN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:DRISKILL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 WASHINGTON ST
Mailing Address - Street 2:EIGHT TOWER BRIDGE, STE 1400
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2083
Mailing Address - Country:US
Mailing Address - Phone:866-825-3227
Mailing Address - Fax:866-825-3227
Practice Address - Street 1:8500 W CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7262
Practice Address - Country:US
Practice Address - Phone:866-825-3227
Practice Address - Fax:866-825-3227
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN000880363LP0808X, 363LP0808X
NVAPN000880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPENDING IN PROCESSMedicaid
PENDING IN PROCESSMedicare ID - Type Unspecified
PENDING IN PROCESSMedicare UPIN