Healthcare Provider Details

I. General information

NPI: 1033109038
Provider Name (Legal Business Name): DEEANNA BENNETT BEAVER APRN, NP.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CORPORATE DRIVE
HOUMA LA
70360-4154
US

IV. Provider business mailing address

1428 DR. BEATROUS RD.
THERIOT LA
70397
US

V. Phone/Fax

Practice location:
  • Phone: 985-851-1001
  • Fax: 985-851-1017
Mailing address:
  • Phone: 985-851-1985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN065304 APO1230
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: