Provider Demographics
NPI:1497169197
Name:BEACH, JACOB CODY (MSN,APRN,FNP-C, CEN)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:CODY
Last Name:BEACH
Suffix:
Gender:M
Credentials:MSN,APRN,FNP-C, CEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23927-9125
Mailing Address - Country:US
Mailing Address - Phone:434-374-5344
Mailing Address - Fax:
Practice Address - Street 1:414 PARK AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4630
Practice Address - Country:US
Practice Address - Phone:434-857-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177331363L00000X
VA0001238176163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency