Beverly Advanced Practice Nursing, PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

AP120067 Issued in TX

Legal business name

BEVERLY ADVANCED PRACTICE NURSING, PLLC

Doing business as

The Beverly Clinic

Practice address

103A Woodbine PL
Longview, TX 75601-2912

Phone

(903) 212-7788

NPI assigned

Dec 18, 2017

Organization subpart

No

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

Authorized official

Name

Daytral Brown, APRNNPI 1154629798

Title

Nurse Practitioner

Phone

(903) 212-7788

Specialties & licenses 1

Addresses

Other names 1

• The Beverly Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Daytral M Brown, NP

  • Primary Care Nurse Practitioner
  • Longview, TX
  • NPI 1154629798
  Medicare reassignment NPD Authorized official
• Travis Schochler

  • Nurse Practitioner
  • Longview, TX
  • NPI 1912862665

  Single Specialty

  NPD

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

{
    "created_epoch": "1513555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513555200000",
    "number": "1609382209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 883",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756060883",
            "telephone_number": "903-212-7788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103A WOODBINE PL",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756012912",
            "telephone_number": "903-212-7788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEVERLY ADVANCED PRACTICE NURSING, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-18",
        "last_updated": "2017-12-18",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "DAYTRAL",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "903-212-7788",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "AP120067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Beverly Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Joseph F Bianca, MD
• Ashish Thekkekara Biju, DPM

• Primary Care Clinic/Center in Longview, TX
• Providers in Longview, TX by specialty
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.