MEDICARE: BEVERLY L. ANDERSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	900103	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	156MF	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1164424404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY L. ANDERSON NP

Provider Business Mailing Address
First Line	:	1032 COLLEGE ST
Second Line	:
City	:	OXFORD
State	:	NC
Zip	:	27565-2571
Country	:	US
Telephone Number	:	919-693-6541
Fax Number	:	919-693-7396

Provider Business Practice Location Address
First Line	:	1032 COLLEGE ST
Second Line	:
City	:	OXFORD
State	:	NC
Zip	:	27565-2571
Country	:	US
Telephone Number	:	919-693-6541
Fax Number	:	919-693-7396

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	04/15/2015

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