Individual
MR. KEVIN BEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6225 HUMPHREYS BLVD, MEMPHIS, TN 38120-2373
(901) 227-9000
Mailing address
PO BOX 945575, ATLANTA, GA 30394-5575
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN 123038
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
APN 10844
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04573508
—
MS
05
—
3633322
—
TN
01
—
4081894
BLUE CROSS OF TN
TN
01
—
99664
BLUE CROSS OF AR
AR
01
—
P00127953
RAILROAD MEDICARE
TN
Enumeration date
05/16/2006
Last updated
08/05/2022
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