Provider Demographics
NPI:1497011936
Name:BEECHAM, TAMIKA ANN
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:ANN
Last Name:BEECHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 GREENBRIAR ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-7214
Mailing Address - Country:US
Mailing Address - Phone:870-740-5218
Mailing Address - Fax:
Practice Address - Street 1:3257 W SARAZENS CIR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-0807
Practice Address - Country:US
Practice Address - Phone:901-590-4106
Practice Address - Fax:901-343-0792
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ARR069730163W00000X
TN32812363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse