Provider Demographics
NPI:1619111606
Name:OLIVER, BEVERLY EAVES (NP)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:EAVES
Last Name:OLIVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N HUMPHREYS BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2177
Mailing Address - Country:US
Mailing Address - Phone:901-226-4003
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:1200 N STATE ST STE 270
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2027
Practice Address - Country:US
Practice Address - Phone:601-714-6470
Practice Address - Fax:601-714-6471
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR604313363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05685057Medicaid
MS05685057Medicaid