Healthcare Provider Details

I. General information

NPI: 1144681883
Provider Name (Legal Business Name): PRISCILLA BEASLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 N FOURCHE AVE
PERRYVILLE AR
72126-8545
US

IV. Provider business mailing address

4196 HIGHWAY 62 412 STE A
HARDY AR
72542-8002
US

V. Phone/Fax

Practice location:
  • Phone: 501-238-1284
  • Fax:
Mailing address:
  • Phone: 870-856-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA004689
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004689
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: