Provider Demographics
NPI:1619157757
Name:BEATTY, KAREN DIANE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:DIANE
Last Name:BEATTY
Suffix:
Gender:F
Credentials:CRNP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:440 MONTICELLO AVE STE 1844
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2571
Mailing Address - Country:US
Mailing Address - Phone:757-773-4567
Mailing Address - Fax:757-282-5748
Practice Address - Street 1:440 MONTICELLO AVE STE 1844
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2571
Practice Address - Country:US
Practice Address - Phone:757-773-3456
Practice Address - Fax:757-282-5748
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2023-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA4812658662084P0800X
PASP008922363LF0000X
VA0024168880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1619157757Medicaid
VA1114956638OtherDR PATRICIA KING - COLLABORATOR
VA1457758393OtherGROUP NPI