MEDICARE: CATHY H. BEATTY CRNP

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	1-065011	AL
2	363L00000X	Nurse Practitioner	106501	AL
3	363L00000X	Nurse Practitioner	1065011	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11990594	OTHER	AL	CAQH
2	1-065011	OTHER	AL	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	511-66113	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1932345485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHY H. BEATTY CRNP

Provider Business Mailing Address
First Line	:	PO BOX 2048
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36652-2048
Country	:	US
Telephone Number	:	251-432-4117
Fax Number	:	251-436-7765

Provider Business Practice Location Address
First Line	:	53 MULBERRY ST
Second Line	:
City	:	FRISCO CITY
State	:	AL
Zip	:	36445-4484
Country	:	US
Telephone Number	:	251-267-2880
Fax Number	:	251-267-2358

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

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	02/16/2016

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