Provider Demographics
NPI:1134601214
Name:BEASLEY, KARIE (AGNP)
Entity type:Individual
Prefix:
First Name:KARIE
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4962 LINCOLN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-4149
Mailing Address - Country:US
Mailing Address - Phone:812-402-3700
Mailing Address - Fax:812-402-4611
Practice Address - Street 1:4962 LINCOLN AVE STE 101
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4149
Practice Address - Country:US
Practice Address - Phone:812-402-3700
Practice Address - Fax:812-402-4611
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28144771A363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300020109Medicaid