Provider Demographics
NPI:1013079490
Name:BEECH, DAPHNE B (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DAPHNE
Middle Name:B
Last Name:BEECH
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 1:1417 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3634
Mailing Address - Country:US
Mailing Address - Phone:901-690-9149
Mailing Address - Fax:901-358-9933
Practice Address - Street 1:1417 MONROE AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3634
Practice Address - Country:US
Practice Address - Phone:901-690-9149
Practice Address - Fax:901-358-9933
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6320363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3906998Medicaid
TNP10157Medicare UPIN
TN3906998Medicaid