Provider Demographics
NPI:1912186032
Name:BEVERLY, LAYLA A (CRNP)
Entity Type:Individual
Prefix:
First Name:LAYLA
Middle Name:A
Last Name:BEVERLY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 AZTEC DR SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-5242
Mailing Address - Country:US
Mailing Address - Phone:256-616-3016
Mailing Address - Fax:256-533-0490
Practice Address - Street 1:4810 WHITESPORT CIR SW
Practice Address - Street 2:SUITE #110
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-7419
Practice Address - Country:US
Practice Address - Phone:256-539-2531
Practice Address - Fax:256-533-0490
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-095870363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-50070OtherBCBS OF ALABAMA
AL515-95255OtherBCBS OF ALABAMA
AL52870110Medicaid
AL515-91763OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL515-94999OtherBCBS OF ALABAMA
AL515-95256OtherBCBS OF ALABAMA
ALCA0084OtherRR MEDICARE
AL515-95001OtherBCBS OF ALABAMA
AL515-95002OtherBCBS OF ALABAMA
AL510-50070OtherBCBS OF ALABAMA
ALCA0084OtherRR MEDICARE