Healthcare Provider Details

I. General information

NPI: 1790576783
Provider Name (Legal Business Name): JUANYETTA BEASLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/16/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 SPRINGSHIRE CT
RALEIGH NC
27610-2561
US

IV. Provider business mailing address

8041 BRIER CREEK PKWY # 1083
RALEIGH NC
27617-7596
US

V. Phone/Fax

Practice location:
  • Phone: 984-381-6313
  • Fax:
Mailing address:
  • Phone: 919-637-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number189613
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: