Provider Demographics
NPI:1629045026
Name:BEACH, AMY REBECCA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:REBECCA
Last Name:BEACH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1684 FOOTE AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-9385
Mailing Address - Country:US
Mailing Address - Phone:716-661-9730
Mailing Address - Fax:716-661-9732
Practice Address - Street 1:1684 FOOTE AVENUE EXT
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-9385
Practice Address - Country:US
Practice Address - Phone:716-661-9730
Practice Address - Fax:716-661-9732
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3308961363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
9511745OtherINDEP HEALTH
00026507402OtherUNIVERA
161570481OtherTAX ID
P00131876OtherRAILROAD MEDICARE
NYF3308961OtherLIC
000560438003OtherCOMM BLUE
NY01568501Medicaid
CA8673OtherRAILROAD MEDICARE
CA8673OtherRAILROAD MEDICARE
P00131876OtherRAILROAD MEDICARE
NY01568501Medicaid
NYF3308961OtherLIC