Provider Demographics
NPI:1699467654
Name:BEVERLY, ASHARA
Entity type:Individual
Prefix:
First Name:ASHARA
Middle Name:
Last Name:BEVERLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 GRIFFON DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6712
Mailing Address - Country:US
Mailing Address - Phone:615-507-0702
Mailing Address - Fax:
Practice Address - Street 1:6584 POPLAR AVE FL 4
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-3687
Practice Address - Country:US
Practice Address - Phone:901-300-6713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant