Healthcare Provider Details

I. General information

NPI: 1649697558
Provider Name (Legal Business Name): ROBIN BEACOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PETROLEUM DR
LAFAYETTE LA
70508-3880
US

IV. Provider business mailing address

2949 S UNION ST
OPELOUSAS LA
70570-5740
US

V. Phone/Fax

Practice location:
  • Phone: 337-988-9999
  • Fax: 337-989-2211
Mailing address:
  • Phone: 337-948-9606
  • Fax: 337-948-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1119375 AP07724
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: