Healthcare Provider Details

I. General information

NPI: 1437823143
Provider Name (Legal Business Name): JENNIFER LYNN RUTH BEAUPRE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19742 W MORNING GLORY ST
BUCKEYE AZ
85326-8203
US

IV. Provider business mailing address

19742 W MORNING GLORY ST
BUCKEYE AZ
85326-8203
US

V. Phone/Fax

Practice location:
  • Phone: 480-725-7871
  • Fax: 480-542-4708
Mailing address:
  • Phone: 480-725-7871
  • Fax: 480-542-4708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number255904
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number63453
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: