Provider Demographics
NPI:1932775368
Name:BEAVERS, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BEAVERS
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 1:9277 LEIVASY RD
Mailing Address - Street 2:
Mailing Address - City:LEIVASY
Mailing Address - State:WV
Mailing Address - Zip Code:26676-4068
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9277 LEIVASY RD
Practice Address - Street 2:
Practice Address - City:LEIVASY
Practice Address - State:WV
Practice Address - Zip Code:26676-4068
Practice Address - Country:US
Practice Address - Phone:304-618-2466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant