Healthcare Provider Details

I. General information

NPI: 1265349450
Provider Name (Legal Business Name): BEVERLEY RENEE SAMMONS APRN, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 BROADWAY AVE
GREAT BEND KS
67530-3633
US

IV. Provider business mailing address

418 CANTERBURY DR
HAYS KS
67601-9542
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-2511
  • Fax:
Mailing address:
  • Phone: 785-259-0951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53-85700-121
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License Number53-85700-121
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: