MEDICARE: EMMY BEATTY CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN099202AP05343	LA

General Provider Information

NPI Number	:	1073820825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMY BEATTY CRNA

Provider Business Mailing Address
First Line	:	14366 CARROL DR
Second Line	:
City	:	WALKER
State	:	LA
Zip	:	70785-7000
Country	:	US
Telephone Number	:	225-268-7833
Fax Number	:

Provider Business Practice Location Address
First Line	:	42144 VETERANS AVE
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1427
Country	:	US
Telephone Number	:	985-542-6344
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2010
Last Update Date	:	08/31/2010

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