Healthcare Provider Details

I. General information

NPI: 1801766936
Provider Name (Legal Business Name): ELECTRA K BEARD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 376
OLIVE BRANCH MS
38654-0376
US

IV. Provider business mailing address

PO BOX 376
OLIVE BRANCH MS
38654-0376
US

V. Phone/Fax

Practice location:
  • Phone: 901-515-8522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number908088
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number40445
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: