Provider Demographics
NPI:1447988779
Name:BEAL, HEATHER MARIE (NP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:BEAL
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 1:12608 LAMPLIGHTER SQUARE SHPG CTR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2746
Mailing Address - Country:US
Mailing Address - Phone:314-842-5600
Mailing Address - Fax:
Practice Address - Street 1:12608 LAMPLIGHTER SQUARE SHPG CTR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2746
Practice Address - Country:US
Practice Address - Phone:314-842-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019046861363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care