Waddell, Beverly Jane

Waddell, Beverly Jane is an individual health care provider with primary practice located at 105 W Stone Dr Ste 5C, Kingsport TN 37660-3365. She recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Gerontology, Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Physician Assistants & Advanced Practice Nursing Providers / Adult Health is her primary health care specialty. Waddell, Beverly Jane can be contacted via phone (423) 378-7645.

Contact Information

Primary practice address
105 W Stone Dr Ste 5C Kingsport TN 37660-3365
Phone: (423) 378-7645
Fax: (423) 392-3863
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 364SG0600X 13413 Tennessee
Nursing Service Providers / Registered Nurse 163W00000X RN129155 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X APN13413 Tennessee

Profile Details

NPI number 1811161813
LBN Legal business name Waddell, Beverly Jane
Credentials ANP, GCNS
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 22nd, 2008
Last updated Nov 18th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811161813 NPPES
Tennessee MEDICAID 1510164

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