Individual
MRS. BEVERLY JOAN GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
131 S WEBB AVE, CROSSVILLE, TN 38555-8452
(931) 484-5379
(931) 484-5946
Mailing address
131 S WEBB AVE, CROSSVILLE, TN 38555-8452
(931) 484-5379
(931) 484-5946
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA632
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00239251
RAILROAD MEDICARE
—
Enumeration date
08/10/2006
Last updated
12/01/2020
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