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General NPI Number Information
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NPI Number | 1033848338
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Entity Type | Individual
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Provider Name | CHARLES JORDAN BEACH APRN
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Gender | Male
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 1 SAINT JOSEPH DR
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City | LEXINGTON
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State | KY
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Zip | 40504-3742
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Country | US
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Telephone | 859-313-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 3449 WINDYKNOLL DR
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City | LEXINGTON
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State | KY
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Zip | 40515-5851
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Country | US
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Telephone | 270-564-5877
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 3017848
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License Number State | KY
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