Provider Demographics
NPI:1427094648
Name:BEATY, JENNIFER SAM (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SAM
Last Name:BEATY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9850 NICHOLAS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2191
Mailing Address - Country:US
Mailing Address - Phone:402-343-1122
Mailing Address - Fax:402-343-1177
Practice Address - Street 1:9850 NICHOLAS ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2191
Practice Address - Country:US
Practice Address - Phone:402-343-1122
Practice Address - Fax:402-343-1177
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE24105208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0490938Medicaid
NE47053395014Medicaid
NECH7569OtherRR MEDICARE
NECH7569Medicare PIN