MEDICARE: KASANDRA BEARDEN

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	363LN0005X	Critical Care Neonatal Nurse Practitioner	685752	TX

General Provider Information

NPI Number	:	1447413042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASANDRA BEARDEN

Provider Business Mailing Address
First Line	:	5906 89TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79424-4598
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2464 CHARLOTTE ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2718
Country	:	US
Telephone Number	:	816-235-1700
Fax Number	:

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

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	07/03/2008

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Directions to “ KASANDRA BEARDEN ” Practice Location

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