Healthcare Provider Details

I. General information

NPI: 1538871769
Provider Name (Legal Business Name): KATHARINE FLEURY BEVAN RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2926 PARKLAND CT
WINTER PARK FL
32789-6641
US

IV. Provider business mailing address

2926 PARKLAND CT
WINTER PARK FL
32789-6641
US

V. Phone/Fax

Practice location:
  • Phone: 843-793-9886
  • Fax:
Mailing address:
  • Phone: 843-793-9886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN-9470428
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: