Healthcare Provider Details

I. General information

NPI: 1639441264
Provider Name (Legal Business Name): KIM I BEUS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 E 1900 S
CLEARFIELD UT
84015
US

IV. Provider business mailing address

383 E 1900 S
CLEARFIELD UT
84015-6223
US

V. Phone/Fax

Practice location:
  • Phone: 801-388-2189
  • Fax:
Mailing address:
  • Phone: 801-388-2189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201500-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201250100NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: