Provider Demographics
NPI:1255313987
Name:BEASLEY, JAMES GLENN (CFNP)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GLENN
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:CFNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:92-112 AWEUWEU PL A
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707
Mailing Address - Country:US
Mailing Address - Phone:808-433-8622
Mailing Address - Fax:
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:
Practice Address - City:TRIPLER AMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-8622
Practice Address - Fax:808-433-8334
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1071363LF0000X
VA0024165406363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily