Provider Demographics
NPI:1689877060
Name:COUCH, BEVERLY JAN
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:JAN
Last Name:COUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BEVERLY
Other - Middle Name:JAN
Other - Last Name:MCCULLOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7424 GREENVILLE AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4534
Mailing Address - Country:US
Mailing Address - Phone:214-363-2004
Mailing Address - Fax:214-696-2091
Practice Address - Street 1:7424 GREENVILLE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4534
Practice Address - Country:US
Practice Address - Phone:214-363-2004
Practice Address - Fax:214-696-2091
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX533003363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health