Healthcare Provider Details

I. General information

NPI: 1306572680
Provider Name (Legal Business Name): CLAUDIA K BEASLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 JET WING DR
COLORADO SPRINGS CO
80916-2332
US

IV. Provider business mailing address

220 RUSKIN DR
COLORADO SPRINGS CO
80910-2522
US

V. Phone/Fax

Practice location:
  • Phone: 719-572-6111
  • Fax:
Mailing address:
  • Phone: 719-572-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2012020160
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: