MEDICARE: REBEKAH KAYLENE BEATY FNP

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	71008104A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912497058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBEKAH KAYLENE BEATY FNP

Provider Business Mailing Address
First Line	:	1645 N DOE VALLEY ROAD
Second Line	:
City	:	PAOLI
State	:	IN
Zip	:	47454
Country	:	US
Telephone Number	:	812-361-5215
Fax Number	:

Provider Business Practice Location Address
First Line	:	8163 W STATE ROAD 56 STE A
Second Line	:
City	:	WEST BADEN SPRINGS
State	:	IN
Zip	:	47469-7706
Country	:	US
Telephone Number	:	812-936-2425
Fax Number	:	812-936-2599

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

Provider Enumeration Date	:	05/15/2018
Last Update Date	:	07/24/2024

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