MEDICARE: CAMISHA LACHELLE BEASLEY BSCPSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1205766524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMISHA LACHELLE BEASLEY BSCPSS

Provider Business Mailing Address
First Line	:	200 TECH CENTER DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37912-2747
Country	:	US
Telephone Number	:	865-637-9711
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 W LAMAR ALEXANDER PKWY
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37801-4555
Country	:	US
Telephone Number	:	865-637-9711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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