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General NPI Number Information
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NPI Number | 1316214935
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Entity Type | Individual
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Provider Name | NANCY DIANE VANEVERY M.S.E., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 2208 FOWLER AVE SUITE C
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City | JONESBORO
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State | AR
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Zip | 72401-6115
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Country | US
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Telephone | 870-931-0808
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Fax |
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Provider Business Mailing Address
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Address Line | 501 APPERSON DR
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City | MARION
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State | AR
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Zip | 72364-2652
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Country | US
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Telephone | 901-270-6724
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1169
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1362
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License Number State | TN
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