Provider Demographics
NPI:1437808821
Name:BEARDEN, CHRISTIAN NICOLE (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:NICOLE
Last Name:BEARDEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 N HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909-9604
Mailing Address - Country:US
Mailing Address - Phone:501-204-9342
Mailing Address - Fax:
Practice Address - Street 1:3901 N HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-9604
Practice Address - Country:US
Practice Address - Phone:501-204-9342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6636225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist