Provider Demographics
NPI:1033109038
Name:BEAVER, DEEANNA BENNETT (APRN, NP)
Entity Type:Individual
Prefix:
First Name:DEEANNA
Middle Name:BENNETT
Last Name:BEAVER
Suffix:
Gender:F
Credentials:APRN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 DR. BEATROUS RD.
Mailing Address - Street 2:
Mailing Address - City:THERIOT
Mailing Address - State:LA
Mailing Address - Zip Code:70397
Mailing Address - Country:US
Mailing Address - Phone:985-851-1985
Mailing Address - Fax:
Practice Address - Street 1:165 CORPORATE DRIVE
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4154
Practice Address - Country:US
Practice Address - Phone:985-851-1001
Practice Address - Fax:985-851-1017
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN065304 APO1230363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health