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General NPI Number Information
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NPI Number | 1083010961
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Entity Type | Individual
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Provider Name | SHELLEYANN BEAUBRUN PMHNP
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Gender | Female
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 04/14/2024
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Provider Practice Location Address
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Address Line | 4136 NEWTON DR NE
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City | COVINGTON
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State | GA
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Zip | 30014-2521
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Country | US
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Telephone | 770-569-3205
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Fax |
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Provider Business Mailing Address
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Address Line | 463 SILVERTON DR
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City | MCDONOUGH
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State | GA
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Zip | 30252-4222
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Country | US
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Telephone |
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | RN193787
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN193787
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License Number State | GA
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