Provider Demographics
NPI:1104304948
Name:BB HEALTH AND WELLNESS
Entity type:Organization
Organization Name:BB HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY AND PMH NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS BYE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-456-2182
Mailing Address - Street 1:16905 FLICKERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21120-9767
Mailing Address - Country:US
Mailing Address - Phone:410-456-2182
Mailing Address - Fax:410-343-0842
Practice Address - Street 1:16905 FLICKERWOOD RD
Practice Address - Street 2:
Practice Address - City:PARKTON
Practice Address - State:MD
Practice Address - Zip Code:21120-9767
Practice Address - Country:US
Practice Address - Phone:410-456-2182
Practice Address - Fax:410-343-0842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO75319363LP0808X
MDR075319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1306843644OtherBEVERLY DAVIS BYE NPI NUMBER