Individual
LESA BEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 362-4471
Mailing address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 362-4471
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
APN0000008070
TN
363LA2100X
Acute Care Nurse Practitioner
RN0000127593
TN
Other
Enumeration date
10/05/2007
Last updated
06/06/2023
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