Healthcare Provider Details

I. General information

NPI: 1225792559
Provider Name (Legal Business Name): PAIGE RAEANNE BEAL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 S WW WHITE RD
SAN ANTONIO TX
78220-2531
US

IV. Provider business mailing address

1032 S WW WHITE RD
SAN ANTONIO TX
78220-2531
US

V. Phone/Fax

Practice location:
  • Phone: 210-447-3033
  • Fax: 210-447-3036
Mailing address:
  • Phone: 210-447-3033
  • Fax: 210-447-3036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1056559
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: