Provider Demographics
NPI:1053853945
Name:BEASLEY, KERRY A (AUD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:A
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31210
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86003-1210
Mailing Address - Country:US
Mailing Address - Phone:928-773-2222
Mailing Address - Fax:928-773-2598
Practice Address - Street 1:77 W FOREST AVE STE 212
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1481
Practice Address - Country:US
Practice Address - Phone:928-773-2222
Practice Address - Fax:928-773-2287
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA10277231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ196468OtherMEDICARE
AZ1053853945OtherUHC
AZ1053853945OtherCIGNA
AZ1053853945OtherHUMANA
AZ1053853945OtherAETNA
AZ213468Medicaid
AZ1053853945OtherAZFMC
AZ1053853945OtherBCBS