Healthcare Provider Details

I. General information

NPI: 1134601214
Provider Name (Legal Business Name): KARIE BEASLEY AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4962 LINCOLN AVE STE 101
EVANSVILLE IN
47715-4149
US

IV. Provider business mailing address

4962 LINCOLN AVE STE 101
EVANSVILLE IN
47715-4149
US

V. Phone/Fax

Practice location:
  • Phone: 812-402-3700
  • Fax: 812-402-4611
Mailing address:
  • Phone: 812-402-3700
  • Fax: 812-402-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number28144771A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number28144771A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: