Provider Demographics
NPI:1821048117
Name:BEALL, VICKY M (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:M
Last Name:BEALL
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 11TH ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:KY
Mailing Address - Zip Code:41008-1435
Mailing Address - Country:US
Mailing Address - Phone:502-732-3270
Mailing Address - Fax:502-732-3289
Practice Address - Street 1:302 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:KY
Practice Address - Zip Code:41095-9304
Practice Address - Country:US
Practice Address - Phone:859-567-2754
Practice Address - Fax:859-567-5108
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3284P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50030474OtherPASSPORT
KY000000697072OtherANTHEM
KY78005501Medicaid
KYP400021101Medicare PIN
KYK021691Medicare PIN