Healthcare Provider Details

I. General information

NPI: 1780887315
Provider Name (Legal Business Name): BEVERLY WILLIAMS JOACHIM N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 2ND ST SW
ROANOKE VA
24016-4923
US

IV. Provider business mailing address

1328 2ND ST SW
ROANOKE VA
24016-4923
US

V. Phone/Fax

Practice location:
  • Phone: 540-342-2844
  • Fax: 540-342-3510
Mailing address:
  • Phone: 540-342-2844
  • Fax: 540-342-3510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024062345
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number0024062345
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: