Nicholas Ryan Beasley, ATC, CSCS, CES
Individual provider Active NPI Athletic Trainer · Moore, OK
NPI 1013404342 · NPPES record last updated Apr 23, 2018
Key facts
- NPI
- 1013404342
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 2000017666 (CO)
- Practice address
- 3701 S I 35 Service Rd
Moore, OK 73160-3183 - Phone
- (405) 912-9000
- NPI assigned
- Apr 23, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000017666 | CO | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2000017666 | CO | Yes |
Addresses
Primary practice location
3701 S I 35 Service Rd
Moore, OK 73160-3183
Mailing address
3720 S Telephone Rd
Moore, OK 73160-2914
Phone (303) 396-7205
Other providers in Moore, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 23, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.