Audrey Louise Beasley

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

10-1092-II42ALASKA Issued in AK

Practice address

1897 Tundra Way
Noorvik, AK 99763

Phone

(907) 636-2103

Fax

(907) 636-2195

NPI assigned

Dec 9, 2011

Last updated

Dec 9, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Audrey Louise Smith Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Maniilaq Association

  dba Sally Harvey Memorial Clinic

  • Federal Public Health Clinic/Center
  • Noorvik, AK
  • NPI 1720355456
  NPD (past)
• Maniilaq Association

  dba Noorvik Clinic

  • Clinic/Center
  • Noorvik, AK
  • NPI 1902552573
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323388800000",
    "number": "1306114970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1897 TUNDRA WAY",
            "address_2": "P.O. BOX 189",
            "city": "NOORVIK",
            "state": "AK",
            "postal_code": "99763",
            "telephone_number": "907-636-2103",
            "fax_number": "907-636-2195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1897 TUNDRA WAY",
            "city": "NOORVIK",
            "state": "AK",
            "postal_code": "99763",
            "telephone_number": "907-636-2103",
            "fax_number": "907-636-2195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEASLEY",
        "first_name": "AUDREY",
        "middle_name": "LOUISE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-09",
        "last_updated": "2011-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "AK",
            "license": "10-1092-II42ALASKA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUDREY",
            "last_name": "SMITH",
            "middle_name": "LOUISE",
            "prefix": "MRS.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Dorothy Lydia Brown, CHP
• Cynthia Ann Coffin, CHP
• Ellen Rose Coffin
• Carol Sophia Field
• Stanley Harvey, CHA I

• Community Health Worker in Noorvik, AK
• Providers in Noorvik, AK by specialty
• Community Health Worker in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.