Provider Demographics
NPI:1104396845
Name:BEARDEN, AIMEE MARCEL (NP-C)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:MARCEL
Last Name:BEARDEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4471 RAY CIR APT C
Mailing Address - Street 2:
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80902-1006
Mailing Address - Country:US
Mailing Address - Phone:808-321-7500
Mailing Address - Fax:
Practice Address - Street 1:1702 E PIKES PEAK AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5717
Practice Address - Country:US
Practice Address - Phone:719-358-7338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60908400163W00000X
CO1674985163W00000X
WAAP60909583363L00000X
COAPN.0996624-NP363L00000X
CORXN.0106199-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse