Healthcare Provider Details

I. General information

NPI: 1689450587
Provider Name (Legal Business Name): KRISTA BEAVER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/21/2024
Certification Date: 09/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 SWEET HOME RD
AMHERST NY
14228-2795
US

IV. Provider business mailing address

1412 SWEET HOME RD
AMHERST NY
14228-2795
US

V. Phone/Fax

Practice location:
  • Phone: 716-589-1411
  • Fax: 716-276-3051
Mailing address:
  • Phone: 716-589-1411
  • Fax: 716-276-3051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number896275
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: