Provider Demographics
NPI:1619911310
Name:BEAUCHAMP, KERMEN D (MD)
Entity Type:Individual
Prefix:DR
First Name:KERMEN
Middle Name:D
Last Name:BEAUCHAMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 HIGHWAY 190
Mailing Address - Street 2:SUITE R
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-5135
Mailing Address - Country:US
Mailing Address - Phone:337-457-2301
Mailing Address - Fax:
Practice Address - Street 1:3521 HIGHWAY 190
Practice Address - Street 2:SUITE R
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5135
Practice Address - Country:US
Practice Address - Phone:337-457-2301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10106R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1976440Medicaid
LA1976440Medicaid