Provider Demographics
NPI:1144359761
Name:BAYS, BEVERLY A (NP)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:BAYS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 PENNSYLVANIA AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-3390
Mailing Address - Country:US
Mailing Address - Phone:304-346-4455
Mailing Address - Fax:304-346-4457
Practice Address - Street 1:830 PENNSYLVANIA AVE STE 301
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3390
Practice Address - Country:US
Practice Address - Phone:304-346-4455
Practice Address - Fax:304-346-4457
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28283363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV28283OtherSTATE LICENSE#
WV2601379000Medicaid
WV2601379000Medicaid