Provider Demographics
NPI:1689867004
Name:DAVIS, BEVERLY ANNE (NP)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:ANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 SW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-3802
Mailing Address - Country:US
Mailing Address - Phone:515-262-8471
Mailing Address - Fax:515-266-9783
Practice Address - Street 1:4821 SW 9TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-3802
Practice Address - Country:US
Practice Address - Phone:515-262-8471
Practice Address - Fax:515-266-9783
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076159363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1689867004Medicaid
IA719260534Medicare PIN