Individual
MRS. BEVERLY JANE WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP, GCNS
Contact information
Practice address
105 W STONE DR, STE 5C, KINGSPORT, TN 37660-3365
(423) 378-7645
(423) 392-3863
Mailing address
PO BOX 9, KINGSPORT, TN 37662-0009
(423) 857-2066
(423) 857-2070
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN129155
TN
363LA2200X
Adult Health Nurse Practitioner
Primary
APN13413
TN
364SG0600X
Gerontology Clinical Nurse Specialist
13413
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1510164
—
TN
Enumeration date
04/22/2008
Last updated
11/18/2014
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