Provider Demographics
NPI:1972869592
Name:BEAMON, KRISTY MICHELLE (PA)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:MICHELLE
Last Name:BEAMON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 SECTION LINE RD STE G
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6188
Mailing Address - Country:US
Mailing Address - Phone:281-429-8522
Mailing Address - Fax:907-600-2610
Practice Address - Street 1:147 SECTION LINE RD STE G
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6188
Practice Address - Country:US
Practice Address - Phone:281-429-8522
Practice Address - Fax:907-600-2610
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-478363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR294880795Medicaid
MO220121732Medicaid