Provider Demographics
NPI:1821231002
Name:CHRISTY, BEVERLY ANN (FNP-C)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 22A
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MO
Mailing Address - Zip Code:63465-9610
Mailing Address - Country:US
Mailing Address - Phone:660-948-3027
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6877
Practice Address - Country:US
Practice Address - Phone:573-221-5250
Practice Address - Fax:573-231-3706
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011008570363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1821231002Medicaid
MO137720032Medicare PIN
MO1821231002Medicaid