Provider Demographics
NPI:1457375008
Name:BEATTIE, JEANNE LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:LOUISE
Last Name:BEATTIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2200 PARK BEND DR
Mailing Address - Street 2:BLDG 2 STE 203
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5592
Mailing Address - Country:US
Mailing Address - Phone:512-339-8831
Mailing Address - Fax:512-339-8841
Practice Address - Street 1:3931 LOUISIANA AVE S
Practice Address - Street 2:SUITE E500
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4375
Practice Address - Country:US
Practice Address - Phone:952-993-1327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN449122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10088Medicaid
MN490687000Medicaid
01032246OtherPREFERRED ONE
05-81580OtherMEDICA
1690679OtherAMERICA'S PPO
373S2BEOtherBLUE CROSS BLUE SHIELD
A013OtherTRIWEST
41-1677590OtherWEA TRUST INSURANCE
130025532OtherRAILROAD MEDICARE
HP37144OtherHEALTHPARTNERS
41-1677590Other1ST CHOICE OF THE MIDWEST
MN490687000Medicaid
ND10088Medicaid