Provider Demographics
NPI:1184934341
Name:GISH, BEVERLY A (RN, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:A
Last Name:GISH
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 W BROAD ST
Mailing Address - Street 2:LOWER LIGHTS CHRISTIAN HEALTH CENTER
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1317
Mailing Address - Country:US
Mailing Address - Phone:614-274-1455
Mailing Address - Fax:614-274-2040
Practice Address - Street 1:1160 W BROAD ST
Practice Address - Street 2:LOWER LIGHTS CHRISTIAN HEALTH CENTER
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1317
Practice Address - Country:US
Practice Address - Phone:614-274-1455
Practice Address - Fax:614-274-2040
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.132275-COA2261QP2300X
OHCOA12895-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care