Healthcare Provider Details

I. General information

NPI: 1295847572
Provider Name (Legal Business Name): BEVERLY A. RIDGWAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 MIDWESTERN PKWY
WICHITA FALLS TX
76302-2211
US

IV. Provider business mailing address

1005 MIDWESTERN PKWY
WICHITA FALLS TX
76302-2211
US

V. Phone/Fax

Practice location:
  • Phone: 940-322-0771
  • Fax: 940-766-4942
Mailing address:
  • Phone: 940-322-0771
  • Fax: 940-766-4942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number661264
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: