MEDICARE: MARTHA LEE BEILSMITH 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	055378	MO

General Provider Information

NPI Number	:	1962408328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA LEE BEILSMITH FNP

Provider Business Mailing Address
First Line	:	2500 EXECUTIVE DRIVE
Second Line	:	SUITE 104
City	:	ST. CHARLES
State	:	MO
Zip	:	63303
Country	:	US
Telephone Number	:	888-811-4677
Fax Number	:

Provider Business Practice Location Address
First Line	:	1145 E CHERRY ST
Second Line	:
City	:	TROY
State	:	MO
Zip	:	63379-1520
Country	:	US
Telephone Number	:	636-528-5712
Fax Number	:

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2007

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