Healthcare Provider Details

I. General information

NPI: 1619270659
Provider Name (Legal Business Name): JULIA C BEAVER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 21ST ST STE 507
LUBBOCK TX
79410-1233
US

IV. Provider business mailing address

2215 NASHVILLE AVE
LUBBOCK TX
79410-1105
US

V. Phone/Fax

Practice location:
  • Phone: 806-725-4805
  • Fax: 806-723-7076
Mailing address:
  • Phone: 806-725-5844
  • Fax: 806-723-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP119633
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: