Provider Demographics
NPI:1932551850
Name:BEAL, TIMBERLYN MASHONDA
Entity Type:Individual
Prefix:
First Name:TIMBERLYN
Middle Name:MASHONDA
Last Name:BEAL
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 1:6208 QUINCE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-7526
Mailing Address - Country:US
Mailing Address - Phone:901-337-3883
Mailing Address - Fax:
Practice Address - Street 1:3360 N WATKINS ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-6432
Practice Address - Country:US
Practice Address - Phone:901-401-7150
Practice Address - Fax:901-347-1285
Is Sole Proprietor?:No
Enumeration Date:2016-07-02
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily