Provider Demographics
NPI:1154002848
Name:BEVIN, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:BEVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MADDIE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1400 HELMRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LYNDON
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3923
Mailing Address - Country:US
Mailing Address - Phone:502-523-2837
Mailing Address - Fax:
Practice Address - Street 1:1400 HELMRIDGE CT
Practice Address - Street 2:
Practice Address - City:LYNDON
Practice Address - State:KY
Practice Address - Zip Code:40222-3923
Practice Address - Country:US
Practice Address - Phone:502-523-2837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula