Healthcare Provider Details

I. General information

NPI: 1518075456
Provider Name (Legal Business Name): MELISSA BEARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 N MAIN ST
KOKOMO IN
46901-4622
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 765-453-8238
  • Fax:
Mailing address:
  • Phone: 317-621-7561
  • Fax: 317-355-6096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004575A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28098238A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: