Healthcare Provider Details

I. General information

NPI: 1104705813
Provider Name (Legal Business Name): MRS. TIFFANY RENEE BEAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 HICKORY NUT TRCE
OLD FORT NC
28762-6867
US

IV. Provider business mailing address

1501 TATE BLVD SE STE 201
HICKORY NC
28602-1385
US

V. Phone/Fax

Practice location:
  • Phone: 828-925-1989
  • Fax:
Mailing address:
  • Phone: 828-322-4140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1024
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: