Provider Demographics
NPI:1942935127
Name:BEVERLY, REBECCA JANE (APRN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:BEVERLY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:174 REBECCA LN
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:KY
Mailing Address - Zip Code:40734-6623
Mailing Address - Country:US
Mailing Address - Phone:606-622-0818
Mailing Address - Fax:
Practice Address - Street 1:39 FERNDALE APARTMENTS RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-8578
Practice Address - Country:US
Practice Address - Phone:731-394-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3016138363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily