Provider Demographics
NPI:1912497058
Name:BEATY, REBEKAH KAYLENE (FNP)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:KAYLENE
Last Name:BEATY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:KAYLENE
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1645 N DOE VALLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:IN
Mailing Address - Zip Code:47454
Mailing Address - Country:US
Mailing Address - Phone:812-361-5215
Mailing Address - Fax:
Practice Address - Street 1:8163 W STATE ROAD 56 STE A
Practice Address - Street 2:
Practice Address - City:WEST BADEN SPRINGS
Practice Address - State:IN
Practice Address - Zip Code:47469-7706
Practice Address - Country:US
Practice Address - Phone:812-936-2425
Practice Address - Fax:812-936-2599
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008104A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300022582Medicaid