Healthcare Provider Details

I. General information

NPI: 1023804754
Provider Name (Legal Business Name): DEANNA MAREE BEANE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 WAYNE SULLIVAN DR
PADUCAH KY
42003-0303
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-9474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF03250351
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: