Individual
MRS. BEVERLY P. WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN, FNP-BC
Contact information
Practice address
3451 GOODMAN RD E, STE 115, SOUTHAVEN, MS 38672-9303
(662) 890-5555
(662) 890-8899
Mailing address
2085 GOODMAN RD W, HORN LAKE, MS 38637-1416
(662) 429-4988
(662) 429-4966
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R629189
MS
363LF0000X
Family Nurse Practitioner
R629189
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00122952
—
MS
Enumeration date
05/15/2006
Last updated
06/16/2025
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