Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 902298 | MS |
NPI | 1033622063 |
---|---|
Provider Name | Angela Aldridge Beem |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2017 |
Last Update Date | 08/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05601764 | (05) | MS |