Healthcare Provider Details

I. General information

NPI: 1740779941
Provider Name (Legal Business Name): LEE ANN BEARD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 ELM STREET
MCADENVILLE NC
28101-0490
US

IV. Provider business mailing address

PO BOX 744786
ATLANTA GA
30374-4786
US

V. Phone/Fax

Practice location:
  • Phone: 704-824-5323
  • Fax: 704-824-5410
Mailing address:
  • Phone: 704-834-2450
  • Fax: 704-671-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number197519
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: