Provider Demographics
NPI:1215083621
Name:BEATTIE, JOANNE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:BEATTIE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 E SHAW AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7904
Mailing Address - Country:US
Mailing Address - Phone:559-226-1316
Mailing Address - Fax:
Practice Address - Street 1:1322 E SHAW AVE STE 410
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7904
Practice Address - Country:US
Practice Address - Phone:559-226-1316
Practice Address - Fax:559-226-1315
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13551363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily