Provider Demographics
NPI:1902687692
Name:BEASLEY, DEANNA
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
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 1:1720 E REELFOOT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-6049
Mailing Address - Country:US
Mailing Address - Phone:901-350-0978
Mailing Address - Fax:901-350-0677
Practice Address - Street 1:1720 E REELFOOT AVE STE 200
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-6049
Practice Address - Country:US
Practice Address - Phone:901-350-0978
Practice Address - Fax:901-350-0677
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34610363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily