Provider Demographics
NPI:1689634487
Name:DOUGLAS, BEVERLY JEAN (ARNP)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JEAN
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 W MOCKINGBIRD LN STE 550
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4902
Mailing Address - Country:US
Mailing Address - Phone:469-904-3555
Mailing Address - Fax:214-819-2405
Practice Address - Street 1:1250 W MOCKINGBIRD LN STE 550
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4902
Practice Address - Country:US
Practice Address - Phone:469-904-3555
Practice Address - Fax:214-819-2405
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9230264363L00000X
TXAP134152363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner