Provider Demographics
NPI:1982641213
Name:BEARD, CAROL L (CRNA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:BEARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:L YNN
Other - Last Name:FRACKELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3207 STONE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-8526
Mailing Address - Country:US
Mailing Address - Phone:330-858-2974
Mailing Address - Fax:
Practice Address - Street 1:4070 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5033
Practice Address - Country:US
Practice Address - Phone:843-652-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2870367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1500Medicaid
SCQ341748436Medicare PIN