Provider Demographics
NPI:1033108162
Name:BELTRAN, CAROL ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:BELTRAN
Suffix:
Gender:F
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 1849
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75802-1849
Mailing Address - Country:US
Mailing Address - Phone:903-677-1000
Mailing Address - Fax:903-677-5586
Practice Address - Street 1:600 S BONHAM ST
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-3603
Practice Address - Country:US
Practice Address - Phone:254-562-5332
Practice Address - Fax:903-677-5586
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX510535367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0023178-06Medicaid
R69506Medicare UPIN
TX0023178-06Medicaid