Provider Demographics
NPI:1962979914
Name:BEATTY, ADAM GARRETT (CRNP)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:GARRETT
Last Name:BEATTY
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-545-4786
Mailing Address - Fax:717-545-6359
Practice Address - Street 1:2151 LINGLESTOWN RD STE 100
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9473
Practice Address - Country:US
Practice Address - Phone:717-545-4786
Practice Address - Fax:717-545-6359
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN592456163W00000X
PASP019810363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse