Provider Demographics
NPI:1891915328
Name:MEYER, BEVERLY J (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:J
Last Name:MEYER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5338 ROYAL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4283
Mailing Address - Country:US
Mailing Address - Phone:503-635-7382
Mailing Address - Fax:
Practice Address - Street 1:2659 COMMERCIAL ST SE
Practice Address - Street 2:SUITE 200
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4445
Practice Address - Country:US
Practice Address - Phone:503-581-0657
Practice Address - Fax:503-581-4025
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR089006838N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health