Provider Demographics
NPI:1891326872
Name:BOUDICA, BEVHION BEATRIX (FNP)
Entity Type:Individual
Prefix:
First Name:BEVHION
Middle Name:BEATRIX
Last Name:BOUDICA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RENEE
Other - Last Name:BEASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2323 E GREENLAW LN STE 7B
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1849
Mailing Address - Country:US
Mailing Address - Phone:928-863-6673
Mailing Address - Fax:928-222-2285
Practice Address - Street 1:2323 E GREENLAW LN STE 7B
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1849
Practice Address - Country:US
Practice Address - Phone:928-863-6673
Practice Address - Fax:928-222-2285
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ270276363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily