Healthcare Provider Details

I. General information

NPI: 1164424404
Provider Name (Legal Business Name): BEVERLY L. ANDERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 COLLEGE ST
OXFORD NC
27565-2571
US

IV. Provider business mailing address

1032 COLLEGE ST
OXFORD NC
27565-2571
US

V. Phone/Fax

Practice location:
  • Phone: 919-693-6541
  • Fax: 919-693-7396
Mailing address:
  • Phone: 919-693-6541
  • Fax: 919-693-7396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number900103
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: