Jennifer A Beverly, RN C

Individual provider Active NPI Registered Nurse · Big Stone Gap, VA

NPI 1093853376 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1093853376
Entity type
Individual (NPI type 1)
Primary specialty
Registered Nurse 163W00000X
License
0001115351 (VA)
Practice address
3169 Second Ave East
Wcbhs
Big Stone Gap, VA 24219
Phone
(276) 523-8300
Fax
(276) 523-6964
NPI assigned
Feb 1, 2007
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
0001115351VAMDRegistered Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 0001115351 VA Yes

Addresses

Primary practice location

3169 Second Ave East
Wcbhs
Big Stone Gap, VA 24219

Mailing address

PO Box 9054
Gray, TN 37615-9054
Phone (423) 467-3600

Other providers in Big Stone Gap, VA

All providers in Big Stone Gap, VA · Registered Nurse in Virginia

Sources for this page

Verify at the official NPI Registry.