Healthcare Provider Details

I. General information

NPI: 1588953756
Provider Name (Legal Business Name): JASON BEVERLEY MS, RN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW ROOM G2055
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-8888
  • Fax: 202-444-4315
Mailing address:
  • Phone: 202-444-8888
  • Fax: 202-444-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN58962
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: