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General NPI Number Information
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NPI Number | 1124067384
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Entity Type | Individual
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Provider Name | BEVERLY ANN CLISBY GLASGOW DNP, FNP, ACNP
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Gender | Female
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 7601 SOUTHCREST PKWY
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City | SOUTHAVEN
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State | MS
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Zip | 38671-4739
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Country | US
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Telephone | 662-349-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 307 WISHING TREE LN
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City | OXFORD
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State | MS
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Zip | 38655-6133
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R503355
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License Number State | MS
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