Provider Demographics
NPI:1275533069
Name:BEATTY-ELLIS, HOPE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:HOPE
Middle Name:
Last Name:BEATTY-ELLIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 VALLEYGATE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3751
Mailing Address - Country:US
Mailing Address - Phone:910-920-1858
Mailing Address - Fax:910-339-9040
Practice Address - Street 1:2135 VALLEYGATE DR STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3751
Practice Address - Country:US
Practice Address - Phone:910-920-1858
Practice Address - Fax:910-339-9040
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2022-04-25
Deactivation Date:2022-03-30
Deactivation Code:
Reactivation Date:2022-04-20
Provider Licenses
StateLicense IDTaxonomies
NC136917367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7002054Medicaid
NCP81922Medicare UPIN
NC2590870Medicare ID - Type UnspecifiedPROVIDER NUMBER