Beverly Gayle Renick, FNP PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA13272 Issued in CA

Practice address

450 Stanyan
2ND Floor Usf Student Medical Clinic St Marys Medical C
San Francisco, CA 94117-1079

Phone

(415) 750-4980

Fax

(415) 750-8155

NPI assigned

Jan 4, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379894400000",
    "number": "1245218932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "779 PORT WALK PLACE",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "94065",
            "telephone_number": "650-622-9943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 STANYAN",
            "address_2": "2ND FLOOR USF STUDENT MEDICAL CLINIC ST MARYS MEDICAL C",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941171079",
            "telephone_number": "415-750-4980",
            "fax_number": "415-750-8155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENICK",
        "first_name": "BEVERLY",
        "middle_name": "GAYLE",
        "credential": "FNP PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-04",
        "last_updated": "2013-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA13272",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "272543",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPIN",
            "identifier": "0PA132720",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Fernando Rendon, MSW
• Michael Dominic Renecle, DO
• Renee Spencer, MFT
• Taylor Renfroe, RD, LD
• Johanna Rengifo Nevarez, PH.D.
• Owen D. Renik, M.D.
• Mark Lee Renneker, MD
• Carolyn Rennels
• Ryan Nguyen Rennels
• Kathryn Elaine Rennie, M.S.

• Physician Assistant in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.