Provider Demographics
NPI:1740805415
Name:BESHORE, J. RICHARD (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:J.
Middle Name:RICHARD
Last Name:BESHORE
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ARAPAHOE AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5862
Mailing Address - Country:US
Mailing Address - Phone:517-282-6852
Mailing Address - Fax:720-815-0406
Practice Address - Street 1:100 ARAPAHOE AVE STE 12
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5862
Practice Address - Country:US
Practice Address - Phone:720-821-5506
Practice Address - Fax:720-815-0406
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996548363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty