1255065132 NPI number — MRS. YOLANDA LYNN BEVERLY FNP-C

Table of content: MRS. YOLANDA LYNN BEVERLY FNP-C (NPI 1255065132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255065132 NPI number — MRS. YOLANDA LYNN BEVERLY FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEVERLY
Provider First Name:
YOLANDA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255065132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 EDWINA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERGREEN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36401-3319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-578-0220
Provider Business Mailing Address Fax Number:
251-578-0223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 PATTERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGIANA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36033-6628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-376-2005
Provider Business Practice Location Address Fax Number:
334-362-4091
Provider Enumeration Date:
07/15/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1-106409 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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