Healthcare Provider Details

I. General information

NPI: 1033111745
Provider Name (Legal Business Name): BEVERLY JOYCE THOMAS-CARTER DNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 N 15TH AVE STE 105
PHOENIX AZ
85015-3329
US

IV. Provider business mailing address

5040 N 15TH AVE STE 105
PHOENIX AZ
85015-3329
US

V. Phone/Fax

Practice location:
  • Phone: 888-958-5736
  • Fax: 888-958-5737
Mailing address:
  • Phone: 888-958-5736
  • Fax: 888-059-5737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP1707
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: