Healthcare Provider Details

I. General information

NPI: 1811334832
Provider Name (Legal Business Name): KARA KEUTHAN BEATTY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 HUGUENOT RD STE 201
MIDLOTHIAN VA
23113
US

IV. Provider business mailing address

1525 HUGUENOT RD STE 201
MIDLOTHIAN VA
23113-2426
US

V. Phone/Fax

Practice location:
  • Phone: 804-415-4113
  • Fax: 804-414-7180
Mailing address:
  • Phone: 804-415-4113
  • Fax: 804-414-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1811334832
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: