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General NPI Number Information
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NPI Number | 1508572454
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Entity Type | Individual
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Provider Name | SAVANNAH BEVERLY
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Gender | Female
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 10415 WALLACE ALLEY ST
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City | KINGSPORT
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State | TN
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Zip | 37663-3936
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Country | US
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Telephone | 423-390-0415
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Fax |
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Provider Business Mailing Address
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Address Line | 2511 BRANDI DR
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City | RUSSELLVILLE
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State | TN
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Zip | 37860-9366
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 245349
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 40797
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License Number State | TN
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