Provider Demographics
NPI:1710239033
Name:BESHEARS, JACQUELINE LEA (FNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:LEA
Last Name:BESHEARS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CONLEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6477
Mailing Address - Country:US
Mailing Address - Phone:573-884-0169
Mailing Address - Fax:573-884-1137
Practice Address - Street 1:601 BUSINESS LOOP 70 W
Practice Address - Street 2:STE. 275
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2585
Practice Address - Country:US
Practice Address - Phone:573-874-0008
Practice Address - Fax:573-875-5350
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012033864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO152360666Medicare PIN