Healthcare Provider Details

I. General information

NPI: 1700323730
Provider Name (Legal Business Name): KELSEY BEAMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2017
Last Update Date: 01/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 GOLDEN ASPEN DR #110
AMES IA
50010-8011
US

IV. Provider business mailing address

203 W 9TH ST
BOONE IA
50036-1919
US

V. Phone/Fax

Practice location:
  • Phone: 515-232-7000
  • Fax:
Mailing address:
  • Phone: 515-391-9756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberQDA-10780
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: