=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053287870
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CASEY BEAMAN CSFA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2025
-----------------------------------------------------
Last Update Date | 10/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 BETHESDA DR
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27834-7201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-847-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5109 GREEN PINE RD
-----------------------------------------------------
City | FARMVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27828-9784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-531-2199
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZC0007X
-----------------------------------------------------
Taxonomy Name | Surgical Assistant
-----------------------------------------------------
License Number | 184334
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------