Healthcare Provider Details

I. General information

NPI: 1043796469
Provider Name (Legal Business Name): JAYCI MICHELLE BEAMER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 PENNSYLVANIA AVE
OTTUMWA IA
52501-2108
US

IV. Provider business mailing address

26867 GARNET AVE
BLOOMFIELD IA
52537-7401
US

V. Phone/Fax

Practice location:
  • Phone: 641-683-4300
  • Fax:
Mailing address:
  • Phone: 641-799-1435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA123953
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: