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General NPI Number Information
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NPI Number | 1629307970
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Entity Type | Individual
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Provider Name | THERESA BEARD RNFA
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Gender | Female
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 11/19/2014
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Provider Practice Location Address
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Address Line | 971 LAKELAND DR SUITE 656
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City | JACKSON
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State | MS
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Zip | 39216-4643
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Country | US
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Telephone | 601-366-6606
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Fax | 601-366-6647
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Provider Business Mailing Address
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Address Line | 971 LAKELAND DR SUITE 656
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City | JACKSON
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State | MS
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Zip | 39216-4643
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Country | US
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Telephone | 601-366-6606
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Fax | 601-366-6647
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | R857458
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License Number State | MS
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