Active NPI
Kenyuana M. Beachem, LCSW
- Clinical Social Worker
- Bolton, MS
National Provider Identifier
1851703961
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C7835
- Practice address
- 4232 S Norrell Rd
Bolton, MS 39041-9240 - Phone
- (601) 624-3696
- NPI assigned
- May 22, 2014
- Last updated
- Dec 3, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C7835 | MS | Primary |
Addresses
Primary practice location
4232 S Norrell Rd
Bolton, MS 39041-9240
Mailing address
4232 S Norrell Rd
Bolton, MS 39041-9240
Phone (601) 624-3696
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C7835 | MS | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Clinical | Current | Accepting new patients |
Interoperability endpoints
- kenyuanawilliams@tdh.allscriptsdirect.net
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1417564800000",
"number": "1851703961",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4232 S NORRELL RD",
"city": "BOLTON",
"state": "MS",
"postal_code": "390419240",
"telephone_number": "601-624-3696"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4232 S NORRELL RD",
"city": "BOLTON",
"state": "MS",
"postal_code": "390419240",
"telephone_number": "601-624-3696"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEACHEM",
"first_name": "KENYUANA",
"middle_name": "M.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-05-22",
"last_updated": "2014-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MS",
"license": "C7835",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bolton, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.