Provider Demographics
NPI:1346640745
Name:BEASLEY, KATISH TANA
Entity Type:Individual
Prefix:
First Name:KATISH
Middle Name:TANA
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 1:221 FIELDSTONE DR APT 3
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-6817
Mailing Address - Country:US
Mailing Address - Phone:937-270-0078
Mailing Address - Fax:
Practice Address - Street 1:221 FIELDSTONE DR APT 3
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-6817
Practice Address - Country:US
Practice Address - Phone:937-270-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0063557OtherPROVIDER NUMBER