Provider Demographics
NPI:1255478640
Name:ARTERBERRY, KATHERYN BEAVERS (FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:KATHERYN
Middle Name:BEAVERS
Last Name:ARTERBERRY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 PINES ROAD
Mailing Address - Street 2:SUITE 1250
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129
Mailing Address - Country:US
Mailing Address - Phone:318-686-3770
Mailing Address - Fax:318-686-3838
Practice Address - Street 1:7505 PINES ROAD
Practice Address - Street 2:SUITE 1250
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129
Practice Address - Country:US
Practice Address - Phone:318-686-3770
Practice Address - Fax:318-686-3838
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN055366 AP02685363LF0000X
LARN055366AP02685363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1680958Medicaid
LA5X779Medicare PIN
LAS75276Medicare UPIN