Provider Demographics
NPI:1093591141
Name:BEASLEY, KYNDEL ELIZABETH
Entity Type:Individual
Prefix:
First Name:KYNDEL
Middle Name:ELIZABETH
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 CASCADE FALLS DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3972
Mailing Address - Country:US
Mailing Address - Phone:615-979-6237
Mailing Address - Fax:
Practice Address - Street 1:4005 CEDAR GLADES DR STE A
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-3203
Practice Address - Country:US
Practice Address - Phone:615-450-1159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician