Provider Demographics
NPI:1124466099
Name:ECHOLES, BEVERLY A (FNP)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:ECHOLES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 REECE RD
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-7500
Mailing Address - Country:US
Mailing Address - Phone:601-405-0374
Mailing Address - Fax:
Practice Address - Street 1:2005 TOWN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1774
Practice Address - Country:US
Practice Address - Phone:601-405-0374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR857333363LF0000X
MDR262168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS5803866OtherAETNA
MS315084YV3YOtherMS MEDICARE
MS12660742OtherCAQH
MS00200062Medicaid