Provider Demographics
NPI:1336490028
Name:BEARD, OBIE (PEST CONTROL)
Entity Type:Individual
Prefix:MR
First Name:OBIE
Middle Name:
Last Name:BEARD
Suffix:
Gender:M
Credentials:PEST CONTROL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 HIGHWAY 138
Mailing Address - Street 2:
Mailing Address - City:TOONE
Mailing Address - State:TN
Mailing Address - Zip Code:38381-8077
Mailing Address - Country:US
Mailing Address - Phone:731-402-1078
Mailing Address - Fax:731-658-4134
Practice Address - Street 1:3575 HIGHWAY 138
Practice Address - Street 2:
Practice Address - City:TOONE
Practice Address - State:TN
Practice Address - Zip Code:38381-8077
Practice Address - Country:US
Practice Address - Phone:731-402-1078
Practice Address - Fax:731-658-4134
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN70304171W00000X
171W00000X
TN171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA55121Medicaid