Provider Demographics
NPI:1972869592
Name:BEAMON, KRISTY MICHELLE (PA)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:MICHELLE
Last Name:BEAMON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 S NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7311
Mailing Address - Country:US
Mailing Address - Phone:417-322-6622
Mailing Address - Fax:417-350-1935
Practice Address - Street 1:2000 S PROMENADE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8609
Practice Address - Country:US
Practice Address - Phone:479-427-7722
Practice Address - Fax:479-427-7721
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023007996363A00000X
ARPA-478363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR294880795Medicaid
MO220121732Medicaid