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General NPI Number Information
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NPI Number | 1154145647
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Entity Type | Organization
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Legal Business Name | BEAN HEALTH AND WELLNESS PLLC
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 105 S MAIN ST
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City | PINCKNEYVILLE
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State | IL
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Zip | 62274-1458
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Country | US
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Telephone | 618-995-8073
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7
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City | PINCKNEYVILLE
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State | IL
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Zip | 62274-0007
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Country | US
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Telephone | 618-995-8073
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Fax |
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Authorized Official
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Title or Position | APRN, FPA, FNP-C
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Name | MRS. KELLI R BEAN
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Credential | APRN, FPA, FNP-C
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Telephone | 618-367-5553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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