Provider Demographics
NPI:1730266313
Name:WEATHERSPOON, BEVERLY H (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:H
Last Name:WEATHERSPOON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:WHALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:809 USHER DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4292
Mailing Address - Country:US
Mailing Address - Phone:615-868-6611
Mailing Address - Fax:
Practice Address - Street 1:1005 DR DB TODD JR BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-3501
Practice Address - Country:US
Practice Address - Phone:615-327-5584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1454363AS0400X
TNPA0000001454363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant