Basic Information
| Provider Information | |||||||||
| NPI: | 1669802310 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEASLEY | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75-5751 KUAKINI HWY | ||||||||
| Address2: | STE 203 | ||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967401753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083265629 | ||||||||
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| Practice Location | |||||||||
| Address1: | 74-5214 KEANALEHU DR | ||||||||
| Address2: | |||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083555600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2013 | ||||||||
| LastUpdateDate: | 02/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9370679 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | APRN-2006 | HI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 803024 | 05 | HI | MEDICAID |