Provider Demographics
NPI:1447962576
Name:BEAL, PATRICIA LYNN (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LYNN
Last Name:BEAL
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:LYNN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1952 NEW CREEK HWY
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-7494
Mailing Address - Country:US
Mailing Address - Phone:304-597-3522
Mailing Address - Fax:304-597-3524
Practice Address - Street 1:1952 NEW CREEK HWY
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-7494
Practice Address - Country:US
Practice Address - Phone:304-597-3522
Practice Address - Fax:304-597-3524
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVR117392163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR117392Medicaid