Healthcare Provider Details

I. General information

NPI: 1922543248
Provider Name (Legal Business Name): KEN BEENE NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 HIGHWAY 45 S
RAMER TN
38367-5224
US

IV. Provider business mailing address

7430 HIGHWAY 45 S
RAMER TN
38367-5224
US

V. Phone/Fax

Practice location:
  • Phone: 731-610-5256
  • Fax:
Mailing address:
  • Phone: 731-610-5256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000022085
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: