Healthcare Provider Details

I. General information

NPI: 1255149340
Provider Name (Legal Business Name): PATRICIA BEAMER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2024
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10619 W NANTUCKET ST
WICHITA KS
67212-1274
US

IV. Provider business mailing address

10619 W NANTUCKET ST
WICHITA KS
67212-1274
US

V. Phone/Fax

Practice location:
  • Phone: 316-677-7062
  • Fax:
Mailing address:
  • Phone: 316-677-7062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number14106367071
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code364SH1100X
TaxonomyHolistic Clinical Nurse Specialist
License Number14106367071
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5375860071
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: