Provider Demographics
NPI:1881305019
Name:BEASLEY, MADISON (PMHNP, RN)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:
Credentials:PMHNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 REMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3735
Mailing Address - Country:US
Mailing Address - Phone:970-237-9378
Mailing Address - Fax:
Practice Address - Street 1:3050 SE DIVISION ST STE 215
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1997
Practice Address - Country:US
Practice Address - Phone:503-622-8964
Practice Address - Fax:503-715-5469
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1666456163WP0808X
OR10003916363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health