Provider Demographics
NPI:1962126821
Name:BEALL, NICHOLAS YEARICK (HIS)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:YEARICK
Last Name:BEALL
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 FLORAL PKWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6707
Mailing Address - Country:US
Mailing Address - Phone:910-392-1982
Mailing Address - Fax:910-392-3926
Practice Address - Street 1:1313 FLORAL PKWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6707
Practice Address - Country:US
Practice Address - Phone:910-392-1982
Practice Address - Fax:910-392-3926
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1641237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist