Healthcare Provider Details

I. General information

NPI: 1316507205
Provider Name (Legal Business Name): BETH HORSEMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETH DARGE

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 SHAWNEE ST
LEAVENWORTH KS
66048-1683
US

IV. Provider business mailing address

2024 SHAWNEE ST
LEAVENWORTH KS
66048-1683
US

V. Phone/Fax

Practice location:
  • Phone: 913-683-8445
  • Fax:
Mailing address:
  • Phone: 913-683-8445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number78863
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number78863
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06190102
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: