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General NPI Number Information
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NPI Number | 1720404205
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Entity Type | Individual
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Provider Name | ANGEL SHELTON BEAVERS
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Gender | Female
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Dates
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Enumeration Date | 03/08/2014
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 1613 OAKWOOD ST
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City | BEDFORD
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State | VA
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Zip | 24523-1213
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Country | US
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Telephone | 800-554-5517
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Fax |
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Provider Business Mailing Address
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Address Line | 6255 BETHANY ROAD
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City | RUSTBURG
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State | VA
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Zip | 24588
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Country | US
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Telephone | 434-258-4426
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001178518
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024171546
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License Number State | VA
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