Healthcare Provider Details

I. General information

NPI: 1386431153
Provider Name (Legal Business Name): COURTNEY BEARDSLEE RN, PSYCH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 DIXIE HWY # 142
CLARKSTON MI
48346-2077
US

IV. Provider business mailing address

7111 DIXIE HWY BOX 142
CLARKSTON MI
48346-2077
US

V. Phone/Fax

Practice location:
  • Phone: 248-567-2334
  • Fax:
Mailing address:
  • Phone: 248-567-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704307242
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4704307242
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: