Active NPI
Kristin Lee Beasley
- Clinical Psychologist
- Fresno, CA
National Provider Identifier
1104237833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSB94020449
- Practice address
- 2080 N Winery Ave
#101
Fresno, CA 93703-4817 - Phone
- (559) 252-6353
- NPI assigned
- May 15, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSB94020449 | CA | Primary |
| Counseling Psychologist | 103TC1900X | PSB94020449 | CA | |
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | PSB94020449 | CA | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | PSB94020449 | CA | |
| Family Psychologist | 103TF0000X | PSB94020449 | CA |
Addresses
Primary practice location
2080 N Winery Ave
#101
Fresno, CA 93703-4817
Mailing address
2080 N Winery Ave
#101
Fresno, CA 93703-4817
Phone (559) 252-6353
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSB94020449 | CA | MD | Family Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edwyn W. Ortiz-Nance Psychological Services | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Preferred Provider Organization
- Fresno, CA
- NPI 1396156030
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400112000000",
"number": "1104237833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2080 N WINERY AVE",
"address_2": "#101",
"city": "FRESNO",
"state": "CA",
"postal_code": "937034817",
"telephone_number": "559-252-6353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2080 N WINERY AVE",
"address_2": "#101",
"city": "FRESNO",
"state": "CA",
"postal_code": "937034817",
"telephone_number": "559-252-6353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEASLEY",
"first_name": "KRISTIN",
"middle_name": "LEE",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-05-15",
"last_updated": "2014-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSB94020449",
"primary": true
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "CA",
"license": "PSB94020449",
"primary": false
},
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "PSB94020449",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "CA",
"license": "PSB94020449",
"primary": false
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "CA",
"license": "PSB94020449",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.