Provider Demographics
NPI:1235815622
Name:BEAN, TOMERICK T
Entity Type:Individual
Prefix:
First Name:TOMERICK
Middle Name:T
Last Name:BEAN
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 1:740C CONFERENCE DR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1915
Mailing Address - Country:US
Mailing Address - Phone:615-779-0351
Mailing Address - Fax:
Practice Address - Street 1:740C CONFERENCE DR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1915
Practice Address - Country:US
Practice Address - Phone:615-779-0351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other