Healthcare Provider Details

I. General information

NPI: 1407240732
Provider Name (Legal Business Name): KAJUANDRIA D BEASLEY-WILLIAMS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 NONCONNAH BLVD
MEMPHIS TN
38132-2108
US

IV. Provider business mailing address

7412 IVY TRAILS CV
OLIVE BRANCH MS
38654-7171
US

V. Phone/Fax

Practice location:
  • Phone: 901-337-1625
  • Fax:
Mailing address:
  • Phone: 668-347-2921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR883048
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004592
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19823
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: