Healthcare Provider Details

I. General information

NPI: 1306843644
Provider Name (Legal Business Name): BEVERLY JUNE DAVIS BYE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16905 FLICKERWOOD RD
PARKTON MD
21120
US

IV. Provider business mailing address

16905 FLICKERWOOD RD
PARKTON MD
21120-9767
US

V. Phone/Fax

Practice location:
  • Phone: 410-456-2182
  • Fax: 410-343-0842
Mailing address:
  • Phone: 410-343-0842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR075319
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN075319
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: