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General NPI Number Information
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NPI Number | 1548246085
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Entity Type | Individual
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Provider Name | CAMILLE MERCEDES GARDNER-BEASLEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 04/02/2019
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Provider Practice Location Address
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Address Line | 9040A JACKSON AVE
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City | JOINT BASE LEWIS MCCHORD
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-968-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 10444 LONGMIRE RD
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City | JOINT BASE LEWIS MCCHORD
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State | WA
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Zip | 98433-1357
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 200700182
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MEDS7564
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 7564
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License Number State | AK
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