Healthcare Provider Details

I. General information

NPI: 1144359761
Provider Name (Legal Business Name): BEVERLY A BAYS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 PENNSYLVANIA AVE STE 301
CHARLESTON WV
25302-3390
US

IV. Provider business mailing address

830 PENNSYLVANIA AVE STE 301
CHARLESTON WV
25302-3390
US

V. Phone/Fax

Practice location:
  • Phone: 304-346-4455
  • Fax: 304-346-4457
Mailing address:
  • Phone: 304-346-4455
  • Fax: 304-346-4457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28283
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: