Beth Mayberry

Key facts

NPI

1407287709

Entity type

Individual (NPI type 1)

Primary specialty

Registered Nurse 163W00000X

License

2010013255 (MO)

Practice address

520 W Madison St
Millstadt, IL 62260-1428

Phone

(618) 980-3819

NPI assigned

Dec 11, 2013

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

Other names

• Beth A Martin Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 11, 2013.

{
    "created_epoch": "1386720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386720000000",
    "number": "1407287709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 W MADISON ST",
            "city": "MILLSTADT",
            "state": "IL",
            "postal_code": "622601428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 W MADISON ST",
            "city": "MILLSTADT",
            "state": "IL",
            "postal_code": "622601428",
            "telephone_number": "618-980-3819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYBERRY",
        "first_name": "BETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-11",
        "last_updated": "2013-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2010013255",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "SC",
            "license": "206901",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BETH",
            "last_name": "MARTIN",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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