Eric Michael Beaulieu, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

29882 Issued in TN

Practice address

2204 Pavilion Dr Ste 108
Kingsport, TN 37660-4651

Phone

(423) 392-6100

Fax

(423) 392-6159

NPI assigned

Jul 19, 2021

Last updated

Nov 18, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: sullivandigestivecenter@directaddress.net

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668729600000",
    "number": "1093388175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2204 PAVILION DR STE 108",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604651",
            "telephone_number": "423-392-6100",
            "fax_number": "423-392-6159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 PAVILION DR STE 108",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604651",
            "telephone_number": "423-392-6100",
            "fax_number": "423-392-6159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAULIEU",
        "first_name": "ERIC",
        "middle_name": "MICHAEL",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-19",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "29882",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q068089",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sullivandigestivecenter@directaddress.net",
            "affiliation": "N",
            "endpointDescription": "Direct Message",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2204 Pavilion Dr Ste 108",
            "city": "Kingsport",
            "state": "TN",
            "country_code": "US",
            "postal_code": "376604651",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sullivandigestivecenter@directaddress.net",
            "affiliation": "N",
            "endpointDescription": "Direct Message",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2204 Pavilion Dr Ste 108",
            "city": "Kingsport",
            "state": "TN",
            "country_code": "US",
            "postal_code": "376604651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Steven J Baumrucker, MD
• Barbara Dawn Bausman, RN, BSN, MS,CCRN-CMC
• Pedro A Bauza-Feliciano, MD
• Mark C Baxter, D.P.M.
• Caleb Bazyler, MD
• James Robert Beck, PHARMACIST
• Rebecca L Beck, CNA
• Mary Elizabeth Becker, MD
• Eric Dean Beckerink, PTA
• James P Beckner, MD

• Family Nurse Practitioner in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.