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General NPI Number Information
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NPI Number | 1336504778
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Entity Type | Individual
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Provider Name | TIA BEASLEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/30/2015
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 109 MULBERRY DR
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City | TUPELO
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State | MS
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Zip | 38801-6993
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Country | US
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Telephone | 662-255-3008
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Fax |
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Provider Business Mailing Address
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Address Line | 109 MULBERRY DR
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City | TUPELO
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State | MS
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Zip | 38801-3175
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Country | US
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Telephone | 662-255-3008
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA00260
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License Number State | MS
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