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NPI Code Detail

MEDICARE: BEVERLY A SMITH FNP

MEDICARE: BEVERLY A SMITH FNP
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
1363LP0200XPediatric Nurse PractitionerC030799IA
2363LP0200XPediatric Nurse PractitionerIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1S53434OTHERUPIN
202874OTHERIAIA BCBS SEEN IN DAVENPORT
342106072440OTHERIAJOHN DEERE HEALTH
4IA0140OTHERIAJOHN DEERE EDI#
593327OTHERIAIA BCBS SEEN IN MOLINE
693357OTHERIAIA BCBS SEEN IN RI
7079471OTHERHEALTH ALLIANCE
85200098OTHERIACONTROLLED SUBSTANCE#

General Provider Information

NPI Number : 1275529430
Entity Type Code : Individual
Provider Name (Legal Business Name) : BEVERLY A SMITH FNP
Provider Business Mailing Address
First Line : 500 W RIVER DR
Second Line :
City : DAVENPORT
State : IA
Zip : 52801-1014
Country : US
Telephone Number : 563-336-3000
Fax Number : 563-336-3044
Provider Business Practice Location Address
First Line : 500 W RIVER DR
Second Line :
City : DAVENPORT
State : IA
Zip : 52801-1014
Country : US
Telephone Number : 563-336-3000
Fax Number : 563-336-3044
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2005
Last Update Date : 03/07/2023

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Directions to “ BEVERLY A SMITH FNP” Practice Location

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