Active NPI
Justice Domonic Beaty, PHARMD
- Pharmacist
- Corbin, KY
National Provider Identifier
1336946870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 024423
- Practice address
- 1 Trillium Way
Corbin, KY 40701-8426 - Phone
- (865) 278-0692
- NPI assigned
- Mar 3, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 48212 | TN | |
| Pharmacist | 183500000X | 024423 | KY | Primary |
Addresses
Primary practice location
1 Trillium Way
Corbin, KY 40701-8426
Mailing address
577 Fulton Rd
Harrogate, TN 37752-3129
Phone (865) 278-0692
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 024423 | KY | MD | Pharmacist |
| 48212 | TN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1740960000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740960000000",
"number": "1336946870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "577 FULTON RD",
"city": "HARROGATE",
"state": "TN",
"postal_code": "377523129",
"telephone_number": "865-278-0692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 TRILLIUM WAY",
"city": "CORBIN",
"state": "KY",
"postal_code": "407018426",
"telephone_number": "865-278-0692"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEATY",
"first_name": "JUSTICE",
"middle_name": "DOMONIC",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-03-03",
"last_updated": "2025-03-03",
"certification_date": "2025-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "48212",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "KY",
"license": "024423",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corbin, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.