Beverly A Smith, FNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

C030799 Issued in IA

Practice address

500 W River Dr
Davenport, IA 52801-1014

Phone

(563) 336-3000

Fax

(563) 336-3044

NPI assigned

Sep 23, 2005

Last updated

Mar 7, 2023By the provider in NPPES

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 8

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Community Health Care, Inc.

  • Dental Clinic/Center
  • Davenport, IA
  • NPI 1598759029
  NPD (past)
• Community Health Care, Inc.

  dba CHC-Adult Rehabilitation Center

  • Federally Qualified Health Center (FQHC)
  • Davenport, IA
  • NPI 1700866605
  NPD (past)
• Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Davenport, IA
  • NPI 1942280235
  NPD (past)
• Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Davenport, IA
  • NPI 1962496679
  NPD (past)
• Community Health Care, Inc.

  dba CHC-IL Homeless Drop In

  • Federally Qualified Health Center (FQHC)
  • Rock Island, IL
  • NPI 1093795981
  NPD (past)
• Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Rock Island, IL
  • NPI 1598759292
  NPD (past)
• Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Moline, IL
  • NPI 1710971486
  NPD (past)

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1275529430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W RIVER DR",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528011014",
            "telephone_number": "563-336-3000",
            "fax_number": "563-336-3044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W RIVER DR",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528011014",
            "telephone_number": "563-336-3000",
            "fax_number": "563-336-3044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "BEVERLY",
        "middle_name": "A",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-23",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IA",
            "license": "C030799",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "S53434",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IA BCBS SEEN IN DAVENPORT",
            "identifier": "02874",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE HEALTH",
            "identifier": "42106072440",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE EDI#",
            "identifier": "IA0140",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IA BCBS SEEN IN MOLINE",
            "identifier": "93327",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IA BCBS SEEN IN RI",
            "identifier": "93357",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "079471",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTROLLED SUBSTANCE#",
            "identifier": "5200098",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kalissa Jo Smiddy
• Cindy Lee Smit, MSW
• Alison Smith, CADC
• Allison Smith
• Austin Smith
• Brianna Katlin Smith, FNP-C, APRN
• Elisa Smith, M.D.
• Gregory V Smith, LISW
• Hannah Smith
• Janis Diane Smith, PH.D.

• Pediatric Nurse Practitioner in Davenport, IA
• Providers in Davenport, IA by specialty
• Pediatric Nurse Practitioner in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.