Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 22816 | TN |
NPI | 1013241207 |
---|---|
Provider Name | Shannon Kaye Beaty |
First Address | Nashville, TN 37228-1805 |
Second Address | Cookeville, TN 38501-2339 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2009 |
Last Update Date | 17/03/2021 |