Individual provider · NPI-1

Kelly Anne Beaver, NP

Nurse Practitioner · Farmington, MO

NPI number1760790786
StatusActive
Last updated in NPPESSep 24, 2010

Details

NPI
1760790786
Entity type
Individual (NPI-1)
Name
Kelly Anne Beaver
Credential
NP
Sex
Female
Sole proprietor
No
Enumeration date
Sep 24, 2010
Last updated
Sep 24, 2010

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363L00000X Nurse Practitioner2006020391MOYes

Practice location

1212 Weber Rd
Farmington, MO 63640-3325

Phone 800-893-9698

Mailing address

200 Corporate Blvd
Suite 201
Lafayette, LA 70508-3870

Phone 800-893-9698

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