Provider Demographics
NPI:1386120343
Name:BEASLEY, DERENDA MARIE (APN)
Entity type:Individual
Prefix:
First Name:DERENDA
Middle Name:MARIE
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 ANTHONY LN
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36352-8418
Mailing Address - Country:US
Mailing Address - Phone:334-648-8779
Mailing Address - Fax:
Practice Address - Street 1:1391 SPEER BLVD STE 360
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2632
Practice Address - Country:US
Practice Address - Phone:303-720-1845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-116363363LF0000X
IL209018576363LP0808X
COC-RXN.0000972-C-NP363LP0808X
MT161408363LP0808X
COC-APN.0002135-C-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily