Provider Demographics
NPI:1144473547
Name:DAVIDSON, BEVERLY (DNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 E OLD HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4160
Mailing Address - Country:US
Mailing Address - Phone:615-865-3994
Mailing Address - Fax:615-865-8176
Practice Address - Street 1:1037 E OLD HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115
Practice Address - Country:US
Practice Address - Phone:615-865-3994
Practice Address - Fax:615-865-8176
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13671363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1517608Medicaid