Provider Demographics
NPI:1932388501
Name:BETHEA, BEVERLY JEAN (RN)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JEAN
Last Name:BETHEA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4272 BERKLEY CT
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-5648
Mailing Address - Country:US
Mailing Address - Phone:240-346-7419
Mailing Address - Fax:
Practice Address - Street 1:4272 BERKLEY CT
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-5648
Practice Address - Country:US
Practice Address - Phone:240-346-7419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001138449163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator