Provider Demographics
NPI:1609307503
Name:BEAUBRUN, OPHENIDE (CRNP)
Entity Type:Individual
Prefix:
First Name:OPHENIDE
Middle Name:
Last Name:BEAUBRUN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 LOWELL DR SE STE 401
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3761
Mailing Address - Country:US
Mailing Address - Phone:256-489-8845
Mailing Address - Fax:256-489-8849
Practice Address - Street 1:420 LOWELL DR SE STE 401
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3761
Practice Address - Country:US
Practice Address - Phone:256-489-8845
Practice Address - Fax:256-489-8849
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-088875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily