MEDICARE: RONALD BEASLEY FNP-C

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	363LF0000X	Family Nurse Practitioner	AP126395	TX

General Provider Information

NPI Number	:	1790186625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD BEASLEY FNP-C

Provider Business Mailing Address
First Line	:	1032 S WW WHITE RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78220-2531
Country	:	US
Telephone Number	:	210-447-3033
Fax Number	:	210-447-3036

Provider Business Practice Location Address
First Line	:	4411 E SOUTHCROSS BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78222-3726
Country	:	US
Telephone Number	:	210-648-9500
Fax Number	:

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

Provider Enumeration Date	:	09/10/2014
Last Update Date	:	05/18/2026

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