Provider Demographics
NPI:1073820338
Name:BEASLEY, STEPHANIE MICHELLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 LEIGH DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-3098
Mailing Address - Country:US
Mailing Address - Phone:662-328-3375
Mailing Address - Fax:662-328-3395
Practice Address - Street 1:724 LEIGH DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-3098
Practice Address - Country:US
Practice Address - Phone:662-328-3375
Practice Address - Fax:662-328-3395
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR855599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00188819Medicaid