Provider Demographics
NPI:1255621512
Name:SOULLI, BETH KATHLEEN (DO)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:KATHLEEN
Last Name:SOULLI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:KATHLEEN
Other - Last Name:CARVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 3014
Mailing Address - Street 2:1015 DUFF AVENUE
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-239-4414
Mailing Address - Fax:515-239-4786
Practice Address - Street 1:1015 DUFF AVENUE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3014
Practice Address - Country:US
Practice Address - Phone:515-239-4414
Practice Address - Fax:515-239-4786
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04688207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology