Healthcare Provider Details

I. General information

NPI: 1932158011
Provider Name (Legal Business Name): KARLA S BEARDSLEY R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12145 ELM ST
PRINCESS ANNE MD
21853-1358
US

IV. Provider business mailing address

PO BOX 1978
SALISBURY MD
21802-1978
US

V. Phone/Fax

Practice location:
  • Phone: 410-651-5135
  • Fax: 410-651-4682
Mailing address:
  • Phone: 410-749-1015
  • Fax: 410-749-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD00953
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: