Provider Demographics
NPI:1629178769
Name:BEASLEY, RITA CAROL (ARNP)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:CAROL
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39272-5669
Mailing Address - Country:US
Mailing Address - Phone:601-372-5843
Mailing Address - Fax:
Practice Address - Street 1:1309 HIGHWAY 35 S
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-5010
Practice Address - Country:US
Practice Address - Phone:601-469-9999
Practice Address - Fax:601-469-9933
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR561193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine