Individual
MRS. ANNETTE D BEASLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1099 MEDICAL CENTER CIR, MAYFIELD, KY 42066-1159
(812) 267-0686
Mailing address
14291 NE 47TH AVE, ANTHONY, FL 32617-2513
(812) 267-0686
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01053156A
IN
207Q00000X
Family Medicine Physician
Primary
35785
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000292351
ANTHEM
IN
05
—
200357830A
—
IN
01
—
M400068689
ANTHEM- ICC
KY
01
—
P00058122
RAILROAD MEDICARE NUMBER
IN
Enumeration date
09/28/2006
Last updated
04/19/2018
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