Provider Demographics
NPI:1588115836
Name:LAFFERTY, BEVERLY LYNN (FNP)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:LYNN
Last Name:LAFFERTY
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:PO BOX 441
Mailing Address - Street 2:267 STANSBURY DEANFIELD RD.
Mailing Address - City:GLEN DANIEL
Mailing Address - State:WV
Mailing Address - Zip Code:25844-0441
Mailing Address - Country:US
Mailing Address - Phone:304-934-6569
Mailing Address - Fax:
Practice Address - Street 1:28 MALLARD CT
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3664
Practice Address - Country:US
Practice Address - Phone:304-252-8409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN78629NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily