Basic Information
| Provider Information | |||||||||
| NPI: | 1831853712 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEARD | ||||||||
| FirstName: | ELLERY | ||||||||
| MiddleName: | ANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4785 BRICKERT CT | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461429633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172922992 | ||||||||
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| Practice Location | |||||||||
| Address1: | 533 E COUNTY LINE RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461431074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174976626 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2021 | ||||||||
| LastUpdateDate: | 10/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | PENDING | IN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.