Provider Demographics
NPI:1679574180
Name:BEADLE, ANN MARIE (ACNP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:BEADLE
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:706-494-3008
Practice Address - Street 1:100 PHYSICIANS WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-8102
Practice Address - Country:US
Practice Address - Phone:615-547-6700
Practice Address - Fax:615-547-6707
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN120773363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3632835Medicaid
TN3632835Medicare ID - Type UnspecifiedMEDICARE, CIGNA, PART B