Provider Demographics
NPI:1962766824
Name:BEESON, NIKIA (NP)
Entity type:Individual
Prefix:
First Name:NIKIA
Middle Name:
Last Name:BEESON
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 1:2705 ENTERPRISE DR # 5
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46013-9670
Mailing Address - Country:US
Mailing Address - Phone:765-393-1965
Mailing Address - Fax:
Practice Address - Street 1:2705 ENTERPRISE DR # 5
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-9670
Practice Address - Country:US
Practice Address - Phone:765-393-1965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28151339A363LW0102X
IN71004228A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201117760Medicaid
IN000000804162OtherANTHEM
IN201117760Medicaid