Healthcare Provider Details

I. General information

NPI: 1700983756
Provider Name (Legal Business Name): AMY T BEANE RD, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 LAUREL VALLEY RD
MARS HILL NC
28754-6787
US

IV. Provider business mailing address

601 SMITH CREEK RD
MARS HILL NC
28754-5765
US

V. Phone/Fax

Practice location:
  • Phone: 828-490-6777
  • Fax:
Mailing address:
  • Phone: 828-490-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL002426
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number234894
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5014153
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: