Healthcare Provider Details

I. General information

NPI: 1790205565
Provider Name (Legal Business Name): JILL RENEE BEYMER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 SAINT JOHN ST
GARDEN CITY KS
67846-5128
US

IV. Provider business mailing address

PO BOX 1051
LAKIN KS
67860-1051
US

V. Phone/Fax

Practice location:
  • Phone: 620-275-1766
  • Fax: 620-275-4729
Mailing address:
  • Phone: 620-290-4003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number77676
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77676
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: