Provider Demographics
NPI:1033827852
Name:BEARD, JEREMY O'BRIEN
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:O'BRIEN
Last Name:BEARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 TUCKER ST # 11
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-4055
Mailing Address - Country:US
Mailing Address - Phone:731-217-6103
Mailing Address - Fax:
Practice Address - Street 1:131 TUCKER ST # 11
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-4055
Practice Address - Country:US
Practice Address - Phone:731-217-6103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities