Healthcare Provider Details

I. General information

NPI: 1346978053
Provider Name (Legal Business Name): AMY BEASLEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 N MCKENZIE ST STE 102
FOLEY AL
36535-2275
US

IV. Provider business mailing address

PO BOX 2048
MOBILE AL
36652-2048
US

V. Phone/Fax

Practice location:
  • Phone: 251-947-1083
  • Fax: 251-947-1084
Mailing address:
  • Phone: 251-432-4117
  • Fax: 251-436-7765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1-118064
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-118064
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: