Healthcare Provider Details

I. General information

NPI: 1912688045
Provider Name (Legal Business Name): THEA BEYER DNP, APRN, CPNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 FLORMANN ST
RAPID CITY SD
57701-4679
US

IV. Provider business mailing address

155 N WILDER BLVD
HERMOSA SD
57744-5424
US

V. Phone/Fax

Practice location:
  • Phone: 612-910-0278
  • Fax: 605-755-3129
Mailing address:
  • Phone: 612-910-0278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberR050996
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number2465896
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCP002999
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: