MEDICARE: KELLY ANN BEAVER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	24958	WV

General Provider Information

NPI Number	:	1245952258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ANN BEAVER

Provider Business Mailing Address
First Line	:	2410 JEFFERSON AVE
Second Line	:
City	:	POINT PLEASANT
State	:	WV
Zip	:	25550-1528
Country	:	US
Telephone Number	:	304-675-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 JEFFERSON AVE
Second Line	:
City	:	POINT PLEASANT
State	:	WV
Zip	:	25550-1527
Country	:	US
Telephone Number	:	304-675-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2022
Last Update Date	:	09/15/2022

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Directions to “ KELLY ANN BEAVER ” Practice Location

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