MEDICARE: MRS. RONDA KAY BEATTY RN

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	RN375323	OH
2	163W00000X	Registered Nurse	RN375323	OH

General Provider Information

NPI Number	:	1891070504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RONDA KAY BEATTY RN

Provider Business Mailing Address
First Line	:	PO BOX 572
Second Line	:
City	:	NEW STRAITSVILLE
State	:	OH
Zip	:	43766-0572
Country	:	US
Telephone Number	:	740-605-4316
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 DAVIS ST
Second Line	:
City	:	NEW STRAITSVILLE
State	:	OH
Zip	:	43766-9540
Country	:	US
Telephone Number	:	740-605-4316
Fax Number	:

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

Provider Enumeration Date	:	10/13/2011
Last Update Date	:	09/22/2023

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