Provider Demographics
NPI:1710126941
Name:BEAN, LASONDRA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LASONDRA
Middle Name:
Last Name:BEAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:LASONDRA
Other - Middle Name:BROWNIECE
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1708
Mailing Address - Country:US
Mailing Address - Phone:702-781-5111
Mailing Address - Fax:
Practice Address - Street 1:201 PARK ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1708
Practice Address - Country:US
Practice Address - Phone:702-781-5111
Practice Address - Fax:270-780-0474
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13838363LF0000X
KY3016657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily