Provider Demographics
NPI:1558709469
Name:BEAL, KATIE (MD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:BEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N KEENE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 MEDICAL CENTER PKWY STE 240A
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3204
Practice Address - Country:US
Practice Address - Phone:479-553-3340
Practice Address - Fax:479-553-1964
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013017461207V00000X
ARE-10369207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology