=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053853945
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KERRY A BEASLEY AU.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2016
-----------------------------------------------------
Last Update Date | 10/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 77 W FOREST AVE STE 212
-----------------------------------------------------
City | FLAGSTAFF
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86001-1481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-773-2222
-----------------------------------------------------
Fax | 928-773-2287
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 31210
-----------------------------------------------------
City | FLAGSTAFF
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86003-1210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-773-2222
-----------------------------------------------------
Fax | 928-773-2598
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | DA10277
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------