Provider Demographics
NPI:1457452963
Name:BEACH, JUDITH (NP)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:BEACH
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 1:610 BURGUNDY DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-3502
Mailing Address - Country:US
Mailing Address - Phone:615-860-1365
Mailing Address - Fax:
Practice Address - Street 1:3380 C ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3920
Practice Address - Country:US
Practice Address - Phone:907-497-2311
Practice Address - Fax:907-497-2310
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK213363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP61741Medicaid