Provider Demographics
NPI:1720612096
Name:BEAM, OLIVIA PAIGE
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:PAIGE
Last Name:BEAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-0337
Mailing Address - Country:US
Mailing Address - Phone:270-297-7332
Mailing Address - Fax:
Practice Address - Street 1:1300 E 9TH ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-0337
Practice Address - Country:US
Practice Address - Phone:270-297-7332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014110363L00000X, 363L00000X
IN71009977A363L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100663010Medicaid
KYARPN3014110OtherSTATE LICENSE
IN71009977AOtherSTATE LICENSE - INDIANA
KYARPN3014110OtherSTATE LICENSE
ININ3604041OtherMEDICARE INDIANA