Healthcare Provider Details

I. General information

NPI: 1962496083
Provider Name (Legal Business Name): BEVERLY M SEARCH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 1ST AVE SW
CASTLE ROCK WA
98611
US

IV. Provider business mailing address

PO BOX 160
CASTLE ROCK WA
98611-0160
US

V. Phone/Fax

Practice location:
  • Phone: 360-274-2353
  • Fax: 360-274-5354
Mailing address:
  • Phone: 360-274-2353
  • Fax: 360-274-2353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00091627
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberRN00091627
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30001705
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberAP30001705
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: