Provider Demographics
NPI:1982069258
Name:FICKLIN, BEVERLY (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:
Last Name:FICKLIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:BRINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4423 SAPELO DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-8222
Mailing Address - Country:US
Mailing Address - Phone:706-825-7364
Mailing Address - Fax:
Practice Address - Street 1:1537 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-3764
Practice Address - Country:US
Practice Address - Phone:706-731-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN191142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily