Healthcare Provider Details

I. General information

NPI: 1821048117
Provider Name (Legal Business Name): VICKY M. BEALL CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W MAIN ST
WARSAW KY
41095-9304
US

IV. Provider business mailing address

309 11TH ST
CARROLLTON KY
41008-1435
US

V. Phone/Fax

Practice location:
  • Phone: 859-567-2754
  • Fax: 859-567-5108
Mailing address:
  • Phone: 502-732-3270
  • Fax: 502-732-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3284P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: