Richard Vincent Beasley, RN, AGNP-C

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

1031030 Issued in TX

Practice address

948 Crannog Way
Conroe, TX 77301-4132

Phone

(936) 788-1173

NPI assigned

Aug 19, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1597795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652486400000",
    "number": "1972115152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "948 CRANNOG WAY",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773014132",
            "telephone_number": "936-788-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "948 CRANNOG WAY",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773014132",
            "telephone_number": "936-788-1173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEASLEY",
        "first_name": "RICHARD",
        "middle_name": "VINCENT",
        "name_prefix": "Mr.",
        "credential": "RN, AGNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-19",
        "last_updated": "2022-05-14",
        "certification_date": "2022-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WH1000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Hospice",
            "state": "TX",
            "license": "631950",
            "primary": false
        },
        {
            "code": "163WP2201X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Ambulatory Care",
            "state": "TX",
            "license": "631950",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "1031030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "rvbeasley@suddenlinlk.net",
            "affiliation": "N",
            "endpointDescription": "Home address",
            "address_1": "948 Crannog Way",
            "city": "Conroe",
            "state": "TX",
            "country_code": "US",
            "postal_code": "773014132",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Gerontology Nurse Practitioner in Conroe, TX
• Providers in Conroe, TX by specialty
• Gerontology Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2022; 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.