Individual provider · NPI-1

Richard Vincent Beasley, RN, AGNP-C

Nurse Practitioner, Gerontology · Conroe, TX

NPI number1972115152

StatusActive

Last updated in NPPESMay 14, 2022

Details

NPI: 1972115152
Entity type: Individual (NPI-1)
Name: Mr. Richard Vincent Beasley
Credential: RN, AGNP-C
Sex: Male
Sole proprietor: Yes
Enumeration date: Aug 19, 2020
Certification date: May 14, 2022
Last updated: May 14, 2022

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
363LG0600X	Nurse Practitioner, Gerontology	1031030	TX	Yes
163WH1000X	Registered Nurse, Hospice	631950	TX
163WP2201X	Registered Nurse, Ambulatory Care	631950	TX

Practice location

948 Crannog Way
Conroe, TX 77301-4132

Phone 936-788-1173

Mailing address

948 Crannog Way
Conroe, TX 77301-4132

Phone 936-788-1173

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