Healthcare Provider Details

I. General information

NPI: 1871933812
Provider Name (Legal Business Name): CAROLYN LOUISE BEVERLY MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 DEEP WOODS CT
DES MOINES IA
50320-2818
US

IV. Provider business mailing address

PO BOX 35153
DES MOINES IA
50315-0302
US

V. Phone/Fax

Practice location:
  • Phone: 515-865-4136
  • Fax:
Mailing address:
  • Phone: 515-865-4136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number33750
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: