Provider Demographics
NPI:1528552528
Name:BEELER, NACHELL TASHAE
Entity Type:Individual
Prefix:
First Name:NACHELL
Middle Name:TASHAE
Last Name:BEELER
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 1:126 N 42ND ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40212-2606
Mailing Address - Country:US
Mailing Address - Phone:502-389-7382
Mailing Address - Fax:502-822-1732
Practice Address - Street 1:126 N 42ND ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40212-2606
Practice Address - Country:US
Practice Address - Phone:502-389-7382
Practice Address - Fax:502-822-1732
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2091941744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty