Healthcare Provider Details

I. General information

NPI: 1982069258
Provider Name (Legal Business Name): BEVERLY FICKLIN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BEVERLY BRINSON

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 WALTON WAY
AUGUSTA GA
30904-3764
US

IV. Provider business mailing address

4423 SAPELO DR
EVANS GA
30809-8222
US

V. Phone/Fax

Practice location:
  • Phone: 706-731-1200
  • Fax:
Mailing address:
  • Phone: 706-825-7364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN191142
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: