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NPI Code Detail

MEDICARE: VICKY BEVERLY

MEDICARE: VICKY BEVERLY
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
1225400000XRehabilitation Practitioner26-1284474NV

General Provider Information

NPI Number : 1184904419
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICKY BEVERLY
Provider Business Mailing Address
First Line : 3840 N COMMERCE ST
Second Line : STE. 200
City : NORTH LAS VEGAS
State : NV
Zip : 89032-8104
Country : US
Telephone Number : 702-646-7570
Fax Number :
Provider Business Practice Location Address
First Line : 3840 N COMMERCE ST
Second Line : STE. 200
City : NORTH LAS VEGAS
State : NV
Zip : 89032-8104
Country : US
Telephone Number : 702-646-7570
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2011
Last Update Date : 08/17/2011

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Directions to “ VICKY BEVERLY ” Practice Location

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