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General NPI Number Information
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NPI Number | 1912772161
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Entity Type | Individual
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Provider Name | CARLA RENEE BEAM
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Gender | Female
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Dates
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Enumeration Date | 11/17/2023
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 2901 SE 22ND ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73129-8413
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Country | US
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Telephone | 405-677-0502
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Fax |
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Provider Business Mailing Address
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Address Line | 7500 S COUNTRY CLUB DR APT 202C
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159-5157
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Country | US
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Telephone | 405-589-5662
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 400043700822
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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