1912186032 NPI number — LAYLA A BEVERLY CRNP

Table of content: LAYLA A BEVERLY CRNP (NPI 1912186032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912186032 NPI number — LAYLA A BEVERLY CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEVERLY
Provider First Name:
LAYLA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912186032
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3016 AZTEC DR SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35603-5242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-616-3016
Provider Business Mailing Address Fax Number:
256-533-0490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4810 WHITESPORT CIR SW
Provider Second Line Business Practice Location Address:
SUITE #110
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-7419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-539-2531
Provider Business Practice Location Address Fax Number:
256-533-0490
Provider Enumeration Date:
10/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  1-095870 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 510-50070 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-95255 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 52870110 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-91763 . This is a "BLUE CROSS BLUE SHIELD OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-94999 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-95256 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: CA0084 . This is a "RR MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-95001 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-95002 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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