Provider Demographics
NPI:1083859383
Name:BEAUDRY, ERIN PATRICIA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:PATRICIA
Last Name:BEAUDRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 BETHCAR CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WAGENER
Mailing Address - State:SC
Mailing Address - Zip Code:29164
Mailing Address - Country:US
Mailing Address - Phone:401-523-4556
Mailing Address - Fax:
Practice Address - Street 1:120 LOUIE ST
Practice Address - Street 2:
Practice Address - City:WAGENER
Practice Address - State:SC
Practice Address - Zip Code:29164-9445
Practice Address - Country:US
Practice Address - Phone:803-564-8803
Practice Address - Fax:803-564-8804
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF4255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP 1787 SCMedicaid
SCNP 1787 SCMedicaid