Provider Demographics
NPI:1134485725
Name:BEAM, ASHLEY PAIGE (CRNA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:PAIGE
Last Name:BEAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 N STATE ST STE 311
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2407
Mailing Address - Country:US
Mailing Address - Phone:601-939-1171
Mailing Address - Fax:
Practice Address - Street 1:2550 FLOWOOD DR
Practice Address - Street 2:#400
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9303
Practice Address - Country:US
Practice Address - Phone:601-933-9521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-08
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR873805163W00000X
MS089139367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03353093Medicaid