Individual
MRS. KELLY LOUISE BEAVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-C
Contact information
Practice address
3100 SAMFORD AVE, SHREVEPORT, LA 71103-4239
(318) 226-3306
(318) 226-3319
Mailing address
P O BOX 8500 LOCK BOX 7642, PHILADELPHIA, PA 19178-7642
(813) 821-8478
(813) 281-8113
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
235754
LA
Other
Enumeration date
06/05/2024
Last updated
06/05/2024
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