Provider Demographics
NPI:1891404216
Name:BEARD, JACKIE (FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JACKIE
Middle Name:
Last Name:BEARD
Suffix:
Gender:F
Credentials:FNP-BC
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 16006
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79906-1006
Mailing Address - Country:US
Mailing Address - Phone:915-209-5043
Mailing Address - Fax:
Practice Address - Street 1:21227 TORCH ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:AP
Practice Address - Zip Code:79918
Practice Address - Country:US
Practice Address - Phone:915-209-5043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1145004363LP2300X
TX711589163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care