Beverly W Clark, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

904987 Issued in MS

Practice address

78 Hospital Rd
Macon, MS 39341-2490

Phone

(662) 361-8338

NPI assigned

Oct 21, 2021

Last updated

Jan 20, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Beverly Darlene White Former name

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Noxubee General Critical Access HospitalGroup PAC ID 9335130798, 16 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mississippi Homecare of Eupora Home health agency, Eupora, MS, CCN 257122
• Noxubee General Critical Access Hosp Hospital, Macon, MS, CCN 251307

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Noxubee General Critical Access Hospital

  • Emergency Medicine Physician
  • Macon, MS
  • NPI 1477793305
  Medicare reassignment Care Compare group NPD
• Noxubee General Critical Access Hospital

  dba Macon Primary Pharmacy

  • Community/Retail Pharmacy
  • Macon, MS
  • NPI 1134616113
  NPD
• Noxubee General Critical Access Hospital

  • Critical Access Hospital
  • Macon, MS
  • NPI 1902844194
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Able Home Health, Inc.

  dba Mississippi HomeCare of Eupora

  • Home Health Agency
  • Eupora, MS
  • NPI 1659483196
  Care Compare affiliation
• Noxubee General Critical Access Hospital

  • Critical Access Hospital
  • Macon, MS
  • NPI 1902844194
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1184387672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4735 HIGHWAY 490 RD",
            "city": "MACON",
            "state": "MS",
            "postal_code": "393419366",
            "telephone_number": "662-361-8338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 HOSPITAL RD",
            "city": "MACON",
            "state": "MS",
            "postal_code": "393412490",
            "telephone_number": "662-361-8338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BEVERLY",
        "middle_name": "W",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-21",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "904987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BEVERLY",
            "last_name": "WHITE",
            "middle_name": "DARLENE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Family Nurse Practitioner in Macon, MS
• Providers in Macon, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.