MEDICARE: BEACH POINT ACUPUNCTURE, LLC

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	171100000X	Acupuncturist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366189854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACH POINT ACUPUNCTURE, LLC

Provider Business Mailing Address
First Line	:	450 HEFFERON DR
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32084-6516
Country	:	US
Telephone Number	:	904-679-6739
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 A1A S STE B1
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32080-7906
Country	:	US
Telephone Number	:	904-679-6739
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KIMBERLY ANN KRAUSE
Credential	:	L AC
Telephone Number	:	603-998-6507

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	05/16/2022

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Directions to “BEACH POINT ACUPUNCTURE, LLC ” Practice Location

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