Healthcare Provider Details

I. General information

NPI: 1740467448
Provider Name (Legal Business Name): MRS. MYLINDA CAROL BEASLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 N. 31ST
CLINTON OK
73601
US

IV. Provider business mailing address

PO BOX 125
COLONY OK
73021
US

V. Phone/Fax

Practice location:
  • Phone: 580-323-6021
  • Fax: 580-323-0828
Mailing address:
  • Phone: 405-929-7320
  • Fax: 580-323-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: