Healthcare Provider Details

I. General information

NPI: 1578507257
Provider Name (Legal Business Name): BEVERLY G WHEELER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOSEPHINE ADAMS M.D.

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 E COURT AVE
JEFFERSONVILLE IN
47130-4028
US

IV. Provider business mailing address

2248 SHAWNEE DR APT. 2
MADISON IN
47250-5106
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-8030
  • Fax: 813-288-8032
Mailing address:
  • Phone: 812-801-7322
  • Fax: 813-288-8032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number26499
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: