Provider Demographics
NPI:1063203222
Name:LARA BELTRAN, KARIME
Entity type:Individual
Prefix:
First Name:KARIME
Middle Name:
Last Name:LARA BELTRAN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N K ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-2267
Mailing Address - Country:US
Mailing Address - Phone:918-910-1159
Mailing Address - Fax:
Practice Address - Street 1:3162 W MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-7679
Practice Address - Country:US
Practice Address - Phone:479-435-6636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR203119235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist