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General NPI Number Information
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NPI Number | 1710239033
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Entity Type | Individual
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Provider Name | JACQUELINE LEA BESHEARS FNP
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Gender | Female
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Dates
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Enumeration Date | 10/10/2012
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 601 BUSINESS LOOP 70 W STE. 275
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City | COLUMBIA
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State | MO
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Zip | 65203-2585
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Country | US
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Telephone | 573-874-0008
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Fax | 573-875-5350
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Provider Business Mailing Address
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Address Line | 25 CONLEY RD
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City | COLUMBIA
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State | MO
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Zip | 65201-6477
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Country | US
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Telephone | 573-884-0169
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Fax | 573-884-1137
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2012033864
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License Number State | MO
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