Provider Demographics
NPI:1699901934
Name:BEACH, KAREN MARIE (NP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:BEACH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3987 LAWRENCEVILLE HWY STE B
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4526
Mailing Address - Country:US
Mailing Address - Phone:770-270-8112
Mailing Address - Fax:770-270-6841
Practice Address - Street 1:3987 LAWRENCEVILLE HWY STE B
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4526
Practice Address - Country:US
Practice Address - Phone:770-270-8112
Practice Address - Fax:770-270-6841
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN132357363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN132357OtherGEORGIA BOARD OF NURSING