MEDICARE: ALEXIS CHEYENNE BEARD APRN

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	363LF0000X	Family Nurse Practitioner	227571	AR

General Provider Information

NPI Number	:	1356104228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS CHEYENNE BEARD APRN

Provider Business Mailing Address
First Line	:	681 LUCY LN
Second Line	:
City	:	ALEXANDER
State	:	AR
Zip	:	72002-7053
Country	:	US
Telephone Number	:	501-762-1184
Fax Number	:

Provider Business Practice Location Address
First Line	:	6640 CONGO RD
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72019-6913
Country	:	US
Telephone Number	:	501-794-4110
Fax Number	:

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

Provider Enumeration Date	:	02/02/2024
Last Update Date	:	02/02/2024

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