Provider Demographics
NPI:1306957006
Name:BEINEMAN, TONYA DEANN (APN RNP)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:DEANN
Last Name:BEINEMAN
Suffix:
Gender:F
Credentials:APN RNP
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 11316
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1316
Mailing Address - Country:US
Mailing Address - Phone:479-434-3131
Mailing Address - Fax:479-434-3135
Practice Address - Street 1:3811 ROGERS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3045
Practice Address - Country:US
Practice Address - Phone:479-434-3131
Practice Address - Fax:479-434-3135
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01596363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR141581758Medicaid
P17765Medicare UPIN
5W155Medicare PIN