Healthcare Provider Details

I. General information

NPI: 1962408328
Provider Name (Legal Business Name): MARTHA LEE BEILSMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 E CHERRY ST
TROY MO
63379-1520
US

IV. Provider business mailing address

2500 EXECUTIVE DRIVE SUITE 104
ST. CHARLES MO
63303
US

V. Phone/Fax

Practice location:
  • Phone: 636-528-5712
  • Fax:
Mailing address:
  • Phone: 888-811-4677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number055378
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: