Provider Demographics
NPI:1972741296
Name:FAUST, BETH MCELWEE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:MCELWEE
Last Name:FAUST
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:BETH
Other - Middle Name:DANIELLE
Other - Last Name:MCELWEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:239 OLD ISLAND TRL
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-4275
Mailing Address - Country:US
Mailing Address - Phone:225-803-4570
Mailing Address - Fax:
Practice Address - Street 1:1908 GRANBY RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37665
Practice Address - Country:US
Practice Address - Phone:994-242-3915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20913367500000X
LA109001367500000X
TN168243367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1512455Medicaid
4232241OtherBCBS