MEDICARE: NYA BEASLEY CM

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		OK

General Provider Information

NPI Number	:	1255808689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NYA BEASLEY CM

Provider Business Mailing Address
First Line	:	6100 S WALKER AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-7026
Country	:	US
Telephone Number	:	405-634-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	11300 SE 15TH ST APT 514
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73130-7816
Country	:	US
Telephone Number	:	480-203-0760
Fax Number	:

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

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	10/24/2018

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Directions to “ NYA BEASLEY CM” Practice Location

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