Healthcare Provider Details

I. General information

NPI: 1093087298
Provider Name (Legal Business Name): CARMIE ANITA BESHEA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 GREENWOOD RD
SHREVEPORT LA
71103-3908
US

IV. Provider business mailing address

424 MAYFAIR DR
BOSSIER CITY LA
71111-2224
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-4000
  • Fax:
Mailing address:
  • Phone: 318-426-3145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP06592
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: