Provider Demographics
NPI:1245692318
Name:BEAMON, LASHANDA MARIE
Entity type:Individual
Prefix:MRS
First Name:LASHANDA
Middle Name:MARIE
Last Name:BEAMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LASHANDA
Other - Middle Name:MARIE
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1335 GERONIMO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-1836
Mailing Address - Country:US
Mailing Address - Phone:915-591-2704
Mailing Address - Fax:915-225-0413
Practice Address - Street 1:6501 N MESA ST
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4435
Practice Address - Country:US
Practice Address - Phone:915-591-2704
Practice Address - Fax:915-225-0413
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129888363LF0000X
GARN199448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily