Provider Demographics
NPI:1497044671
Name:BEAN, KATIE (DMS, PA-C, MHS PA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:BEAN
Suffix:
Gender:F
Credentials:DMS, PA-C, MHS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 CRESTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-3913
Mailing Address - Country:US
Mailing Address - Phone:407-353-8865
Mailing Address - Fax:
Practice Address - Street 1:1694 ROUTE 9
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-930-7486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1953363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical