Provider Demographics
NPI:1972115152
Name:BEASLEY, RICHARD VINCENT (RN, AGNP-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:VINCENT
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:RN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 CRANNOG WAY
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-4132
Mailing Address - Country:US
Mailing Address - Phone:936-788-1173
Mailing Address - Fax:
Practice Address - Street 1:948 CRANNOG WAY
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-4132
Practice Address - Country:US
Practice Address - Phone:936-788-1173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX631950163WH1000X, 163WP2201X
TX1031030363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care