Provider Demographics
NPI:1407510464
Name:BEAM, STACEY A
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:A
Last Name:BEAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:A
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 SAND MINE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BERKELEY SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25411-7457
Mailing Address - Country:US
Mailing Address - Phone:304-258-3096
Mailing Address - Fax:
Practice Address - Street 1:106 SAND MINE RD STE 1
Practice Address - Street 2:
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411-7457
Practice Address - Country:US
Practice Address - Phone:304-258-3096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant