Healthcare Provider Details

I. General information

NPI: 1528552528
Provider Name (Legal Business Name): NACHELL TASHAE BEELER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 N 42ND ST
LOUISVILLE KY
40212-2606
US

IV. Provider business mailing address

126 N 42ND ST
LOUISVILLE KY
40212-2606
US

V. Phone/Fax

Practice location:
  • Phone: 502-389-7382
  • Fax: 502-822-1732
Mailing address:
  • Phone: 502-389-7382
  • Fax: 502-822-1732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number209194
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: