Healthcare Provider Details

I. General information

NPI: 1548421464
Provider Name (Legal Business Name): BEVERLY ANN BYRD NP/RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3634 ELIZABETH ST
RIVERSIDE CA
92506-2506
US

IV. Provider business mailing address

17828 PIRES AVE
CERRITOS CA
90703-8722
US

V. Phone/Fax

Practice location:
  • Phone: 951-341-8935
  • Fax: 951-341-8932
Mailing address:
  • Phone: 562-926-4067
  • Fax: 562-926-4067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number432327
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: