MEDICARE: KAYSE FIELDS BEASLEY MS, CCC-SLP

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	235Z00000X	Speech-Language Pathologist	5465	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285795674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYSE FIELDS BEASLEY MS, CCC-SLP

Provider Business Mailing Address
First Line	:	105 FLORIDA AVE UNIT 2
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-5802
Country	:	US
Telephone Number	:	252-717-8005
Fax Number	:	877-335-6220

Provider Business Practice Location Address
First Line	:	105 FLORIDA AVE
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-5802
Country	:	US
Telephone Number	:	252-717-8005
Fax Number	:	877-335-6220

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	05/09/2022

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