Healthcare Provider Details

I. General information

NPI: 1922931922
Provider Name (Legal Business Name): NICOLE BEASLEY, PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 YORKTOWN DR
CHARLOTTESVILLE VA
22901-3035
US

IV. Provider business mailing address

1727 YORKTOWN DR
CHARLOTTESVILLE VA
22901-3035
US

V. Phone/Fax

Practice location:
  • Phone: 415-336-5343
  • Fax:
Mailing address:
  • Phone: 415-336-5343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: NICOLE WORDLAW
Title or Position: COACH
Credential: PHD
Phone: 415-336-5343