Provider Demographics
NPI:1922062710
Name:SZUKIS, BEVERLY A (APRN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:SZUKIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 DOWELL ROAD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642
Mailing Address - Country:US
Mailing Address - Phone:270-866-2440
Mailing Address - Fax:270-866-2442
Practice Address - Street 1:124 DOWELL ROAD
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642
Practice Address - Country:US
Practice Address - Phone:270-866-2440
Practice Address - Fax:270-866-2442
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002293363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78001690Medicaid
KY0299036Medicare PIN
KY78001690Medicaid