Provider Demographics
NPI:1306847058
Name:BEAM, KIM A (CRNA)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:A
Last Name:BEAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14303 W SHORE CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-6228
Mailing Address - Country:US
Mailing Address - Phone:804-739-8993
Mailing Address - Fax:804-739-4265
Practice Address - Street 1:2010 BREMO RD
Practice Address - Street 2:SUITE 132
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2444
Practice Address - Country:US
Practice Address - Phone:804-285-0680
Practice Address - Fax:804-282-6365
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001075268367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA430002027Medicare ID - Type UnspecifiedPROVIDER NUMBER