Provider Demographics
NPI:1386735116
Name:BEAVERS, LAUREN (APRN, BC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BEAVERS
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 ELDERBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63040-2124
Mailing Address - Country:US
Mailing Address - Phone:901-848-4581
Mailing Address - Fax:
Practice Address - Street 1:222 S WOODS MILL RD STE 360
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:636-489-0179
Practice Address - Fax:314-205-6786
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012036363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3709227Medicare PIN