Provider Demographics
NPI:1982356028
Name:BEDEIR, LAURA LEIGH (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEIGH
Last Name:BEDEIR
Suffix:
Gender:F
Credentials:FNP-C
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 7469
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-7469
Mailing Address - Country:US
Mailing Address - Phone:229-237-3889
Mailing Address - Fax:
Practice Address - Street 1:1001 WARD ST W
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2263
Practice Address - Country:US
Practice Address - Phone:912-384-7120
Practice Address - Fax:912-384-5130
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN102694363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily