Provider Demographics
NPI:1073665261
Name:BEAUCHAMP, KATHERINE MARIE (BSN, RN)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MARIE
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:BEAUCHAMP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:7102 N 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-8676
Mailing Address - Country:US
Mailing Address - Phone:602-944-0040
Mailing Address - Fax:
Practice Address - Street 1:4330 N 62ND ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-1911
Practice Address - Country:US
Practice Address - Phone:480-484-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN045638163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ626236Medicaid