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General NPI Number Information
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NPI Number | 1346883980
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Entity Type | Individual
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Provider Name | KRISTEN MONIQUE BEARD
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Gender | Female
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Dates
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Enumeration Date | 10/27/2019
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | 45 DIMOCK ST
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City | ROXBURY
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State | MA
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Zip | 02119-1208
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Country | US
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Telephone | 617-442-8800
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Fax | 617-442-4088
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Provider Business Mailing Address
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Address Line | 229 MARION ST APT 1
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City | BOSTON
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State | MA
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Zip | 02128-4033
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Country | US
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Telephone | 202-423-9548
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 2313284
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License Number State | MA
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