Healthcare Provider Details

I. General information

NPI: 1407839749
Provider Name (Legal Business Name): BEVERLY BECK GOODWIN FNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 CAMPUS BOX
ELON NC
27244-2010
US

IV. Provider business mailing address

20 HEATHER CT
GIBSONVILLE NC
27249-2753
US

V. Phone/Fax

Practice location:
  • Phone: 336-278-7230
  • Fax: 336-538-6506
Mailing address:
  • Phone: 336-449-5338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201688
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: