Healthcare Provider Details

I. General information

NPI: 1639024490
Provider Name (Legal Business Name): BEATY ELIZABETH HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W COUNTRY CLUB RD
ROSWELL NM
88201-5209
US

IV. Provider business mailing address

201 LAKE CASTLE RD
MADISON MS
39110-8619
US

V. Phone/Fax

Practice location:
  • Phone: 575-622-8170
  • Fax:
Mailing address:
  • Phone: 769-972-1726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: