Provider Demographics
NPI:1871520429
Name:BEAM, LARONDA COLLINS (FNP-BC)
Entity type:Individual
Prefix:
First Name:LARONDA
Middle Name:COLLINS
Last Name:BEAM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LARONDA
Other - Middle Name:GAYLE
Other - Last Name:COLLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, RN
Mailing Address - Street 1:PO BOX 5777
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-5777
Mailing Address - Country:US
Mailing Address - Phone:865-980-4897
Mailing Address - Fax:865-977-4796
Practice Address - Street 1:907 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5015
Practice Address - Country:US
Practice Address - Phone:865-980-4897
Practice Address - Fax:865-977-4796
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3907060Medicaid
TN3907060Medicaid
TN103I508336Medicare PIN