Provider Demographics
NPI:1285019380
Name:BEASLEY, JAMES CALVIN JR (DNP AG-ACNP-BC, FNP-)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CALVIN
Last Name:BEASLEY
Suffix:JR
Gender:M
Credentials:DNP AG-ACNP-BC, FNP-
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5200
Mailing Address - Country:US
Mailing Address - Phone:901-765-2180
Mailing Address - Fax:901-685-3499
Practice Address - Street 1:5959 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5200
Practice Address - Country:US
Practice Address - Phone:901-765-2180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily