MEDICARE: BEVERLY L LEAVY CNA

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	376K00000X	Nurse's Aide	CN0014251381	GA

General Provider Information

NPI Number	:	1285582973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY L LEAVY CNA

Provider Business Mailing Address
First Line	:	2172 GEORGIA ST
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46407-3212
Country	:	US
Telephone Number	:	219-318-9169
Fax Number	:

Provider Business Practice Location Address
First Line	:	3851 LINCOLN JONES RD
Second Line	:
City	:	ELLENWOOD
State	:	GA
Zip	:	30294-1828
Country	:	US
Telephone Number	:	219-318-9169
Fax Number	:

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

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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Directions to “ BEVERLY L LEAVY CNA” Practice Location

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