Provider Demographics
NPI:1174128706
Name:BEARD, KELLI (ARNP)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:BEARD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:BEARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:3343 US HIGHWAY 84 STE 103
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-2158
Mailing Address - Country:US
Mailing Address - Phone:912-807-9355
Mailing Address - Fax:
Practice Address - Street 1:3343 US HIGHWAY 84 STE 103
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-2158
Practice Address - Country:US
Practice Address - Phone:912-807-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022261363L00000X
GAGAA-NP001344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner