Provider Demographics
NPI:1790864635
Name:BUCHANAN, BEVERLY C (RN, PHD, CWCN-APRN)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:C
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:RN, PHD, CWCN-APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1175 PINE ACRES RD
Mailing Address - Street 2:
Mailing Address - City:TERRY
Mailing Address - State:MS
Mailing Address - Zip Code:39170-7627
Mailing Address - Country:US
Mailing Address - Phone:601-878-6908
Mailing Address - Fax:601-878-2400
Practice Address - Street 1:1500 E WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5116
Practice Address - Country:US
Practice Address - Phone:601-362-4471
Practice Address - Fax:601-364-1305
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR523623163WW0000X, 163WE0900X
MSR523623/#2002148630364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy