Provider Demographics
NPI:1730245044
Name:BEVERLY, PATRICIA JENNIE (CNM)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JENNIE
Last Name:BEVERLY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CHANDLER AVENUE
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1649
Mailing Address - Country:US
Mailing Address - Phone:585-344-4700
Mailing Address - Fax:585-345-4191
Practice Address - Street 1:33 CHANDLER AVENUE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1649
Practice Address - Country:US
Practice Address - Phone:585-344-4700
Practice Address - Fax:585-345-4191
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300227-1163W00000X
NYF420625-1363LW0102X
NYF000608367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY030441930OtherUNITED HEALTH CARE
NY030441930OtherNORTH AMERICA
NY030441930OtherMAGNA
NY01680831Medicaid
NY420001817OtherRR MEDICARE
NY9512011OtherIHA
NYP010000608OtherBLUE CHOICE
NY00025293702OtherUNIVERA
NY030441930OtherTRICARE
NY030441930OtherNOVA
NY030441930OtherCOMMERICAL INS
NY106117CQOtherPREFERRED CARE
NY000560239002OtherBCBS WNY
NY1899835OtherGHI
NY030441930OtherAETNA
NY10600600OtherFIDELIS
NYP020000608OtherBCBS ROCHESTER
NY030441930OtherNORTH AMERICA
NY1899835OtherGHI