Healthcare Provider Details

I. General information

NPI: 1861452781
Provider Name (Legal Business Name): BEVERLY JEANNE DEGRANDCHAMP ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 FAIRVIEW ST
CLINTON NC
28328
US

IV. Provider business mailing address

176 WALMART PLZ
SYLVA NC
28779-5808
US

V. Phone/Fax

Practice location:
  • Phone: 910-596-2400
  • Fax:
Mailing address:
  • Phone: 828-631-9462
  • Fax: 828-631-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1090612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: