Provider Demographics
NPI:1811264419
Name:BEASLEY, KARA (MS RD LDN)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 WINTHROP RD
Mailing Address - Street 2:APT 8
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4691
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1330 BEACON ST
Practice Address - Street 2:SUITE 225
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3282
Practice Address - Country:US
Practice Address - Phone:617-332-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-27
Last Update Date:2011-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3146133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered