Provider Demographics
NPI:1285931055
Name:DENTON, BEVERLY KAY
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:KAY
Last Name:DENTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7075
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-7075
Mailing Address - Country:US
Mailing Address - Phone:816-261-6719
Mailing Address - Fax:
Practice Address - Street 1:2411 MARY ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-1534
Practice Address - Country:US
Practice Address - Phone:816-261-6719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO376J00000XOtherHOME HEALTH
MO374U00000XOtherHOME HEALTH