Provider Demographics
NPI:1003815697
Name:BEATY, STEVEN L (CRNA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:BEATY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2344
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2344
Mailing Address - Country:US
Mailing Address - Phone:866-857-4190
Mailing Address - Fax:800-731-0751
Practice Address - Street 1:1994 GALLATIN PIKE N
Practice Address - Street 2:SUITE 202
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2026
Practice Address - Country:US
Practice Address - Phone:615-851-0001
Practice Address - Fax:615-851-0021
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL74000290Medicaid
TN3125002OtherBCBS NUMBER
TN3624353Medicaid
TN3125002OtherBCBS NUMBER