Individual
TRACEY BEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1201 ELY ST, KENNETT, MO 63857-1336
(573) 888-5925
(573) 717-7059
Mailing address
1201 ELY ST, KENNETT, MO 63857-1336
(573) 888-5925
(573) 717-7059
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/09/2014
Last updated
06/09/2014
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