MEDICARE: LINDA JONES BEAUREGARD

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	30294	TN

General Provider Information

NPI Number	:	1447921192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA JONES BEAUREGARD

Provider Business Mailing Address
First Line	:	PO BOX 10613
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38308-0110
Country	:	US
Telephone Number	:	731-267-2214
Fax Number	:

Provider Business Practice Location Address
First Line	:	708 W FOREST AVE
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-3957
Country	:	US
Telephone Number	:	731-267-2214
Fax Number	:

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

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	02/02/2022

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Directions to “ LINDA JONES BEAUREGARD ” Practice Location

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