Healthcare Provider Details

I. General information

NPI: 1134485725
Provider Name (Legal Business Name): ASHLEY PAIGE BEAM CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2012
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 FLOWOOD DR #400
FLOWOOD MS
39232-9303
US

IV. Provider business mailing address

1151 N STATE ST STE 311
JACKSON MS
39202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 601-933-9521
  • Fax:
Mailing address:
  • Phone: 601-939-1171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR873805
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number089139
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: