Provider Demographics
NPI:1861903692
Name:LIVINGSTON, BEVERLY BURNS (FNP-C)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:BURNS
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 N DAVIS AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2355
Mailing Address - Country:US
Mailing Address - Phone:662-579-3958
Mailing Address - Fax:866-962-6149
Practice Address - Street 1:2363 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-8337
Practice Address - Country:US
Practice Address - Phone:662-334-1253
Practice Address - Fax:662-741-2700
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03184569Medicaid