Provider Demographics
NPI:1932825809
Name:DEDUAL, BEVERLY G
Entity Type:Individual
Prefix:MISS
First Name:BEVERLY
Middle Name:G
Last Name:DEDUAL
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 1:18114 S VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAUCIER
Mailing Address - State:MS
Mailing Address - Zip Code:39574-6520
Mailing Address - Country:US
Mailing Address - Phone:228-263-4352
Mailing Address - Fax:
Practice Address - Street 1:18114 S VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAUCIER
Practice Address - State:MS
Practice Address - Zip Code:39574-6520
Practice Address - Country:US
Practice Address - Phone:228-263-4352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer