MEDICARE: MRS. KRISTY LEE BEAMS PMHNP

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	9203802	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP9203802	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2023033477	OTHER	FL	AMERICAN NURSE CREDENTIALING CENTER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952829731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTY LEE BEAMS PMHNP

Provider Business Mailing Address
First Line	:	12443 SAN JOSE BLVD STE 604
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8652
Country	:	US
Telephone Number	:	561-266-8866
Fax Number	:	561-404-4735

Provider Business Practice Location Address
First Line	:	12443 SAN JOSE BLVD STE 604
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8652
Country	:	US
Telephone Number	:	561-266-8866
Fax Number	:	561-404-4735

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

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	11/17/2023

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