Provider Demographics
NPI:1205479953
Name:BEACHUM, KAGAN
Entity type:Individual
Prefix:
First Name:KAGAN
Middle Name:
Last Name:BEACHUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:EAST CALAIS
Mailing Address - State:VT
Mailing Address - Zip Code:05650-8240
Mailing Address - Country:US
Mailing Address - Phone:802-279-9340
Mailing Address - Fax:
Practice Address - Street 1:100 CLIFF DR
Practice Address - Street 2:
Practice Address - City:EAST CALAIS
Practice Address - State:VT
Practice Address - Zip Code:05650-8240
Practice Address - Country:US
Practice Address - Phone:802-279-9340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program