1053853945 NPI number — KERRY A BEASLEY AU.D

Table of content: KERRY A BEASLEY AU.D (NPI 1053853945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053853945 NPI number — KERRY A BEASLEY AU.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEASLEY
Provider First Name:
KERRY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AU.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053853945
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLAGSTAFF
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86003-1210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-773-2222
Provider Business Mailing Address Fax Number:
928-773-2598

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 W FOREST AVE STE 212
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLAGSTAFF
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86001-1481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-773-2222
Provider Business Practice Location Address Fax Number:
928-773-2287
Provider Enumeration Date:
11/09/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  DA10277 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Z196468 . This is a "MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1053853945 . This is a "UHC" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1053853945 . This is a "CIGNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1053853945 . This is a "HUMANA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1053853945 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 213468 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1053853945 . This is a "AZFMC" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1053853945 . This is a "BCBS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com