Healthcare Provider Details

I. General information

NPI: 1639081607
Provider Name (Legal Business Name): STEPHANIE LYNN BEANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE LYNN SHURTER

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR UNIT MEDDAC
FT CARSON CO
80913-4604
US

IV. Provider business mailing address

3320 MARBLE TER
COLORADO SPRINGS CO
80906-4640
US

V. Phone/Fax

Practice location:
  • Phone: 719-503-7239
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN9636764
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: