Healthcare Provider Details

I. General information

NPI: 1912497058
Provider Name (Legal Business Name): REBEKAH KAYLENE BEATY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BECKY KAYLENE BERRY

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8163 W STATE ROAD 56 STE A
WEST BADEN SPRINGS IN
47469-7706
US

IV. Provider business mailing address

1645 N DOE VALLEY ROAD
PAOLI IN
47454
US

V. Phone/Fax

Practice location:
  • Phone: 812-936-2425
  • Fax: 812-936-2599
Mailing address:
  • Phone: 812-361-5215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008104A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: