Provider Demographics
NPI:1922751494
Name:BEESLEY, MISTY
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:BEESLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:
Other - Last Name:BEESLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPM, LDEM
Mailing Address - Street 1:772 E HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2221
Mailing Address - Country:US
Mailing Address - Phone:408-595-1954
Mailing Address - Fax:
Practice Address - Street 1:772 E HARRISON AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2221
Practice Address - Country:US
Practice Address - Phone:408-595-1954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12578587-3400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife