| NPI | 1124488317 |
|---|---|
| Former Name | KELLI BEASLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP11562) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP128449) |
| Enumeration Date | 2016-03-01 |
| Last Update Date | 2018-08-22 |