Provider Demographics
NPI:1083076236
Name:BEESON, KIRSTEN LOGRANDE (MD)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LOGRANDE
Last Name:BEESON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 RIDGEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8504
Mailing Address - Country:US
Mailing Address - Phone:919-876-9797
Mailing Address - Fax:
Practice Address - Street 1:901 RIDGEFIELD DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8504
Practice Address - Country:US
Practice Address - Phone:919-876-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-27
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDL-265-469-044-096207V00000X
NC202300326207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology