Provider Demographics
NPI:1831399807
Name:BEARD, TANYA MAE (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:MAE
Last Name:BEARD
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:MAE
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2207
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756
Mailing Address - Country:US
Mailing Address - Phone:541-771-0751
Mailing Address - Fax:541-504-5805
Practice Address - Street 1:203 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2117
Practice Address - Country:US
Practice Address - Phone:541-771-0751
Practice Address - Fax:541-504-5805
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200750080NP363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274723Medicaid
OR139794Medicare PIN