Provider Demographics
NPI:1700569647
Name:BEAM, KRISTEN REBECCA (CRNP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:REBECCA
Last Name:BEAM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 QUAKER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FISHERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15539-9723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2040 QUAKER VALLEY RD
Practice Address - Street 2:
Practice Address - City:FISHERTOWN
Practice Address - State:PA
Practice Address - Zip Code:15539-9723
Practice Address - Country:US
Practice Address - Phone:814-839-2470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027997363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily