Provider Demographics
NPI:1528496627
Name:HELMS, BEVERLY (RN, CP, BOCPO, LPO)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:HELMS
Suffix:
Gender:F
Credentials:RN, CP, BOCPO, LPO
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:PO BOX 451557
Mailing Address - Street 2:GRAND PROSTHETICS LIGHTWEIGHT ARTIFICIAL LIMBS
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74345-1557
Mailing Address - Country:US
Mailing Address - Phone:918-786-4626
Mailing Address - Fax:801-998-0979
Practice Address - Street 1:5 E 14TH ST
Practice Address - Street 2:GRAND PROSTHETICS LIGHTWEIGHT ARTIFICIAL LIMBS
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-5347
Practice Address - Country:US
Practice Address - Phone:918-786-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0067715163W00000X
222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No163W00000XNursing Service ProvidersRegistered Nurse
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1171400001Medicare UPIN