Provider Demographics
NPI:1215546007
Name:BEAM, BRANDI LEE
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:LEE
Last Name:BEAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1257 PRATER RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:41164-9309
Mailing Address - Country:US
Mailing Address - Phone:606-315-4623
Mailing Address - Fax:
Practice Address - Street 1:1257 PRATER RD
Practice Address - Street 2:
Practice Address - City:OLIVE HILL
Practice Address - State:KY
Practice Address - Zip Code:41164-9309
Practice Address - Country:US
Practice Address - Phone:606-315-4623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY84338163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse