Provider Demographics
NPI:1700259108
Name:BEASLEY, MELISSA (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 GEORGIA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5590
Mailing Address - Country:US
Mailing Address - Phone:912-871-2200
Mailing Address - Fax:912-871-2220
Practice Address - Street 1:450 GEORGIA AVE STE B
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5590
Practice Address - Country:US
Practice Address - Phone:912-871-2200
Practice Address - Fax:912-871-2220
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN204841363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily