Basic Information
| Provider Information | |||||||||
| NPI: | 1134485725 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEAM | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | PAIGE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1151 N STATE ST STE 311 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392022407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019391171 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2550 FLOWOOD DR | ||||||||
| Address2: | #400 | ||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392329303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019339521 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2012 | ||||||||
| LastUpdateDate: | 03/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R873805 | MS | N | Nursing Service Providers | Registered Nurse | 367500000X | 089139 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 03353093 | 05 | MS | MEDICAID |