Healthcare Provider Details

I. General information

NPI: 1851594808
Provider Name (Legal Business Name): MISS BEVERLY ANNE STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 WEST 28TH AVENUE
PINE BLUFF AR
71603-5054
US

IV. Provider business mailing address

PO BOX 2260
PINE BLUFF AR
71613-2260
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-8304
  • Fax: 870-534-8407
Mailing address:
  • Phone: 870-534-8304
  • Fax: 870-534-8407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number5633
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number283
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: