Provider Demographics
NPI:1205571973
Name:BEASLEY, MARINDA MARGARET (APRN)
Entity type:Individual
Prefix:MS
First Name:MARINDA
Middle Name:MARGARET
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARINDA
Other - Middle Name:MARGARET
Other - Last Name:BRINDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:149 MOORE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2918
Mailing Address - Country:US
Mailing Address - Phone:859-335-1330
Mailing Address - Fax:
Practice Address - Street 1:149 MOORE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2918
Practice Address - Country:US
Practice Address - Phone:859-335-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1152836163WC0200X
KY3018472363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3018472OtherKENTUCKY BOARD OF NURSING