Provider Demographics
NPI:1790186625
Name:BEASLEY, RONALD (FNP-C)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 S WW WHITE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220-2531
Mailing Address - Country:US
Mailing Address - Phone:210-447-3033
Mailing Address - Fax:210-447-3036
Practice Address - Street 1:559 10TH ST
Practice Address - Street 2:STE 1
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-3165
Practice Address - Country:US
Practice Address - Phone:830-393-9152
Practice Address - Fax:830-393-9138
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily