Provider Demographics
NPI:1023411683
Name:TIPTON, BEVERLY D (NP-C)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:D
Last Name:TIPTON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12502 WILLOWBROOK RD STE 640
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6579
Mailing Address - Country:US
Mailing Address - Phone:240-964-8717
Mailing Address - Fax:
Practice Address - Street 1:12502 WILLOWBROOK RD STE 640
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6579
Practice Address - Country:US
Practice Address - Phone:240-967-8717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR147398363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily