Healthcare Provider Details

I. General information

NPI: 1922520311
Provider Name (Legal Business Name): BEVERLY CONNER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 SPARKS DR
FOREST CITY NC
28043-9021
US

IV. Provider business mailing address

1100 TUNNEL RD
ASHEVILLE NC
28805-2576
US

V. Phone/Fax

Practice location:
  • Phone: 828-288-6320
  • Fax:
Mailing address:
  • Phone: 828-298-7911
  • Fax: 828-299-5872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5009665
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5009665
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: