Provider Demographics
NPI:1245225564
Name:BEAN, IRENE (FNP)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:BEAN
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 1:913 GALLATIN PIKE S
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4603
Mailing Address - Country:US
Mailing Address - Phone:615-915-2481
Mailing Address - Fax:615-915-2488
Practice Address - Street 1:913 GALLATIN PIKE S
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4603
Practice Address - Country:US
Practice Address - Phone:615-915-2481
Practice Address - Fax:615-915-2488
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000105493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1295988822OtherGROUP NPI
TN00000000OtherUNITED HEALTH CARE
TN10070838OtherAMERIGROUP
TN4192700OtherBLUE CROSS BLUE SHIELD
TN000000OtherAMERICHOICE
TN39093091OtherMEDICARE
TN263063462OtherSERENITY HEALTH CARE
TN1245225564OtherNPI
TN39093091Medicaid
TN1245225564OtherNPI