MEDICARE: STANLEY MARK BEVIS APN

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	363LF0000X	Family Nurse Practitioner	APN11551	TN
2	363LF0000X	Family Nurse Practitioner	AP145756	TX

General Provider Information

NPI Number	:	1962455451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY MARK BEVIS APN

Provider Business Mailing Address
First Line	:	PO BOX 1022
Second Line	:
City	:	WAYNESBORO
State	:	TN
Zip	:	38485-1022
Country	:	US
Telephone Number	:	931-722-2369
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 US HIGHWAY 79 S
Second Line	:
City	:	HENDERSON
State	:	TX
Zip	:	75654
Country	:	US
Telephone Number	:	903-717-3260
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	06/11/2020

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Directions to “ STANLEY MARK BEVIS APN” Practice Location

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