Provider Demographics
NPI:1326132432
Name:BEAN, KAREN ANN (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:BEAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WILDER
Mailing Address - State:ID
Mailing Address - Zip Code:83676-5540
Mailing Address - Country:US
Mailing Address - Phone:208-482-7430
Mailing Address - Fax:208-482-7272
Practice Address - Street 1:124 5TH ST
Practice Address - Street 2:
Practice Address - City:WILDER
Practice Address - State:ID
Practice Address - Zip Code:83676-5540
Practice Address - Country:US
Practice Address - Phone:208-482-7430
Practice Address - Fax:208-482-7272
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-757A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDNPYA8OtherBLUE CROSS OF IDAHO
ID000010158677OtherREGENCE BLUE SHIELD OF ID