Provider Demographics
NPI:1699865105
Name:BEALS, DAWN R (ARNP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:R
Last Name:BEALS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4804 W CLEARWATER AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2119
Mailing Address - Country:US
Mailing Address - Phone:509-942-2355
Mailing Address - Fax:509-222-1289
Practice Address - Street 1:1100 GOETHALS DRIVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3304
Practice Address - Country:US
Practice Address - Phone:509-942-3080
Practice Address - Fax:509-942-3085
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007547364SR0400X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SR0400XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500653648Medicaid
WA169865105Medicaid
WAG8915736Medicare PIN