Provider Demographics
NPI:1265513592
Name:BEASLEY, KAREN ROSE (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ROSE
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:920 PAVERSTONE DRIVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615
Mailing Address - Country:US
Mailing Address - Phone:919-896-6998
Mailing Address - Fax:919-896-6414
Practice Address - Street 1:920 PAVERSTONE DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615
Practice Address - Country:US
Practice Address - Phone:919-896-6998
Practice Address - Fax:919-896-6414
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2005001582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901398Medicaid
NC5901398Medicaid