Provider Demographics
NPI:1982767497
Name:SUMMER, BEVERLY E (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:E
Last Name:SUMMER
Suffix:
Gender:F
Credentials:WHNP-BC
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 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 WELLNESS BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2871
Practice Address - Country:US
Practice Address - Phone:803-732-4608
Practice Address - Fax:803-732-4692
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1434363L00000X, 363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAPN 1434OtherNURSE PRACTITIONER NUMBER