Healthcare Provider Details

I. General information

NPI: 1962979914
Provider Name (Legal Business Name): ADAM GARRETT BEATTY CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 LINGLESTOWN RD STE 100
HARRISBURG PA
17110-9473
US

IV. Provider business mailing address

409 S 2ND ST STE 2F
HARRISBURG PA
17104-1612
US

V. Phone/Fax

Practice location:
  • Phone: 717-545-4786
  • Fax: 717-545-6359
Mailing address:
  • Phone: 717-545-4786
  • Fax: 717-545-6359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN592456
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP019810
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: