Provider Demographics
NPI:1750579967
Name:REILLY, BEVERLY ANN (ANP-C)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
Last Name:REILLY
Suffix:
Gender:F
Credentials:ANP-C
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 84068
Mailing Address - Street 2:SENIOR HEALTH ASSOCIATES
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073
Mailing Address - Country:US
Mailing Address - Phone:843-757-1173
Mailing Address - Fax:866-527-0937
Practice Address - Street 1:335 PLEASANT POINT DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-1164
Practice Address - Country:US
Practice Address - Phone:843-757-1173
Practice Address - Fax:866-527-0937
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704231115363LA2200X
SC18184363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2334Medicaid
SCNP2334Medicaid