Provider Demographics
NPI:1578244158
Name:BEAUDRY, SARA (RN)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:BEAUDRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:WELKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4324 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5578
Mailing Address - Country:US
Mailing Address - Phone:602-327-2836
Mailing Address - Fax:
Practice Address - Street 1:500 EISENHOWER RD STE 101
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5161
Practice Address - Country:US
Practice Address - Phone:913-250-2000
Practice Address - Fax:913-250-2039
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-155526-112163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse