Provider Demographics
NPI:1851594808
Name:STEVENS, BEVERLY ANNE
Entity Type:Individual
Prefix:MISS
First Name:BEVERLY
Middle Name:ANNE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2260
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71613-2260
Mailing Address - Country:US
Mailing Address - Phone:870-534-8304
Mailing Address - Fax:870-534-8407
Practice Address - Street 1:2500 WEST 28TH AVENUE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5054
Practice Address - Country:US
Practice Address - Phone:870-534-8304
Practice Address - Fax:870-534-8407
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5633237700000X
AR283237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49875OtherARKANSAS BLUE CROSS BLUE
AR2P0195OtherARK REHABILITATION SERVIC