Healthcare Provider Details

I. General information

NPI: 1700569647
Provider Name (Legal Business Name): KRISTEN REBECCA BEAM CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

787 GOUCHER ST
JOHNSTOWN PA
15905-3028
US

IV. Provider business mailing address

612 N MAIN ST
BUTLER PA
16001-4363
US

V. Phone/Fax

Practice location:
  • Phone: 814-255-5539
  • Fax:
Mailing address:
  • Phone: 724-431-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP027997
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: