Provider Demographics
NPI:1932345485
Name:BEATTY, CATHY H (CRNP)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:H
Last Name:BEATTY
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:PO BOX 2048
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36652-2048
Mailing Address - Country:US
Mailing Address - Phone:251-432-4117
Mailing Address - Fax:251-436-7765
Practice Address - Street 1:53 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:FRISCO CITY
Practice Address - State:AL
Practice Address - Zip Code:36445-4484
Practice Address - Country:US
Practice Address - Phone:251-267-2880
Practice Address - Fax:251-267-2358
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-065011363LF0000X
AL106501363L00000X
AL1065011363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL11990594OtherCAQH
AL1-065011OtherSTATE LICENSE
AL169114Medicaid
AL511-66113OtherBCBS
AL1-065011OtherSTATE LICENSE