Provider Demographics
NPI:1679758502
Name:MCGEE, BETH K (LPN)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:K
Last Name:MCGEE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W THIRD ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-6032
Mailing Address - Country:US
Mailing Address - Phone:601-807-8288
Mailing Address - Fax:228-284-4335
Practice Address - Street 1:122 W THIRD ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-6032
Practice Address - Country:US
Practice Address - Phone:601-807-8288
Practice Address - Fax:228-284-4335
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP313431164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770297Medicaid