Healthcare Provider Details

I. General information

NPI: 1821289281
Provider Name (Legal Business Name): BEVERLY KIM HUFFMAN BUMGARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16405 NORTHCROSS DR SUITE G2
HUNTERSVILLE NC
28078-5091
US

IV. Provider business mailing address

4135 22ND ST NE
HICKORY NC
28601-7449
US

V. Phone/Fax

Practice location:
  • Phone: 704-897-2450
  • Fax:
Mailing address:
  • Phone: 828-302-4219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number4192
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: