Provider Demographics
NPI:1740467448
Name:BEASLEY, MYLINDA CAROL
Entity type:Individual
Prefix:MRS
First Name:MYLINDA
Middle Name:CAROL
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:COLONY
Mailing Address - State:OK
Mailing Address - Zip Code:73021
Mailing Address - Country:US
Mailing Address - Phone:405-929-7320
Mailing Address - Fax:580-323-0828
Practice Address - Street 1:90 N. 31ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601
Practice Address - Country:US
Practice Address - Phone:580-323-6021
Practice Address - Fax:580-323-0828
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator