Provider Demographics
NPI:1649697558
Name:BEACOM, ROBIN
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:BEACOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2949 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5740
Mailing Address - Country:US
Mailing Address - Phone:337-948-9606
Mailing Address - Fax:337-948-7003
Practice Address - Street 1:200 PETROLEUM DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3880
Practice Address - Country:US
Practice Address - Phone:337-988-9999
Practice Address - Fax:337-989-2211
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN1119375 AP07724363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily