Provider Demographics
NPI:1619218849
Name:DAVIS BEEZLEY, PAMELA (PMHNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:DAVIS BEEZLEY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:DAVIS-BEEZLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN/PMHNP
Mailing Address - Street 1:200 W MAGNOLIA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7657
Mailing Address - Country:US
Mailing Address - Phone:817-702-2977
Mailing Address - Fax:817-702-4243
Practice Address - Street 1:501 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-1006
Practice Address - Country:US
Practice Address - Phone:817-702-3100
Practice Address - Fax:817-702-4606
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX732656363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX319714702Medicaid
TX319714701Medicaid
TX8599NAOtherBCBS
TX285522YRK5Medicare PIN