Healthcare Provider Details

I. General information

NPI: 1386343648
Provider Name (Legal Business Name): BEVERLY FENDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BEVERLY EARNEST

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W IOWA AVE
BONIFAY FL
32425-2103
US

IV. Provider business mailing address

539 FANNY ANN WAY
FREEPORT FL
32439-7613
US

V. Phone/Fax

Practice location:
  • Phone: 850-339-9045
  • Fax: 888-545-1603
Mailing address:
  • Phone: 850-339-9045
  • Fax: 888-545-1603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90304
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: