Basic Information
| Provider Information | |||||||||
| NPI: | 1003268848 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEASLEY | ||||||||
| FirstName: | SPENSER | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 719 GREEN VALLEY RD | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362729447 | ||||||||
| FaxNumber: | 3362722112 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 E WENDOVER AVE STE 311 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362726161 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2016 | ||||||||
| LastUpdateDate: | 08/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5008695 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.