Provider Demographics
NPI:1639441264
Name:BEUS, KIM I (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:I
Last Name:BEUS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 E 1900 S
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-6223
Mailing Address - Country:US
Mailing Address - Phone:801-388-2189
Mailing Address - Fax:
Practice Address - Street 1:383 E 1900 S
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015
Practice Address - Country:US
Practice Address - Phone:801-388-2189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT201500-4405363LF0000X
OR201250100NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500648185Medicaid
UT1639441264Medicaid