Provider Demographics
NPI:1982030599
Name:BEALL, CARRIE (FNP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:BEALL
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 1:1220 12TH ST SE STE 120
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3733
Mailing Address - Country:US
Mailing Address - Phone:202-715-7900
Mailing Address - Fax:
Practice Address - Street 1:1660 COLUMBIA RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-3602
Practice Address - Country:US
Practice Address - Phone:202-328-3717
Practice Address - Fax:202-548-8600
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR100446363LF0000X
DCRN58858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily