Provider Demographics
NPI:1871566992
Name:WILSON, BEVERLY J (ANP-BC, AOCN)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:J
Last Name:WILSON
Suffix:
Gender:F
Credentials:ANP-BC, AOCN
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:J
Other - Last Name:HELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-502-8752
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4321 WASHINGTON ST STE 4000
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5965
Practice Address - Country:US
Practice Address - Phone:816-932-3300
Practice Address - Fax:816-932-5793
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102987163W00000X, 363LA2200X
KS14-76838-112163W00000X
OR10031168363LA2200X
KS46266363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
P97418Medicare UPIN
KSK40000066Medicare PIN
KSP00953234Medicare PIN
MO1871566992Medicaid
KSP00953234Medicare PIN