Provider Demographics
NPI:1235288515
Name:BEASLEY, ELLEN C (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:C
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JIMMIE
Other - Middle Name:ELLEN
Other - Last Name:BEASLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:416 N SEMINARY ST
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-4657
Mailing Address - Country:US
Mailing Address - Phone:256-764-7710
Mailing Address - Fax:256-765-3888
Practice Address - Street 1:416 N SEMINARY ST
Practice Address - Street 2:SUITE 2500
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-4657
Practice Address - Country:US
Practice Address - Phone:256-764-7710
Practice Address - Fax:256-765-3888
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-054374363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4133557OtherBLUE CROSS & BLUE SHIELD
AL515-30969OtherBLUE CROSS & BLUE SHIELD
TN4133557OtherBLUE CROSS & BLUE SHIELD