Healthcare Provider Details

I. General information

NPI: 1750293221
Provider Name (Legal Business Name): JENNIFER BEACHAM FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14006 RIVERSIDE DR STE 18
SHERMAN OAKS CA
91423-1949
US

IV. Provider business mailing address

14631 DICKENS ST APT 9
SHERMAN OAKS CA
91403-5209
US

V. Phone/Fax

Practice location:
  • Phone: 818-331-4386
  • Fax:
Mailing address:
  • Phone: 818-331-4386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95040436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: