Provider Demographics
NPI:1285604132
Name:BEARD, MICHELLE (N,P)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BEARD
Suffix:
Gender:F
Credentials:N,P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 GOVERNOR MANLY WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7360
Mailing Address - Country:US
Mailing Address - Phone:919-570-7550
Mailing Address - Fax:919-570-7551
Practice Address - Street 1:11200 GOVERNOR MANLY WAY STE 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7360
Practice Address - Country:US
Practice Address - Phone:919-570-7550
Practice Address - Fax:919-570-7551
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009397363LA2100X
VA0024164605363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
P45210Medicare UPIN