Healthcare Provider Details

I. General information

NPI: 1740101237
Provider Name (Legal Business Name): BEVERLY CARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7697 COUNTY ROAD 180
KENTON OH
43326-9346
US

IV. Provider business mailing address

7697 COUNTY ROAD 180
KENTON OH
43326-9346
US

V. Phone/Fax

Practice location:
  • Phone: 567-674-0026
  • Fax:
Mailing address:
  • Phone: 567-674-0026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number3300856
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: