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General NPI Number Information
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NPI Number | 1639290323
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Entity Type | Individual
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Provider Name | SIDNEY MAX BEASLEY II ANP
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 4001 WAGON WHEEL RD
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City | SPRINGDALE
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State | AR
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Zip | 72762-0137
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Country | US
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Telephone | 479-725-3000
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Fax | 479-725-3098
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Provider Business Mailing Address
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Address Line | PO BOX 1065
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City | LOWELL
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State | AR
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Zip | 72745-1065
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Country | US
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Telephone | 479-725-3000
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Fax | 479-725-3098
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A01629
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License Number State | AR
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