| Doctor Name: | MR. JAMES GLENN BEASLEY |
| NPI Number: | 1255313987 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CFNP |
| License Number: | 0024165406 |
| Business Practice Address: | 480 Central Ave Pearl Harbor, HI - 968604908 |
| Business Phone Number: | 8084731880 |
| Business Fax Number: | 8084733638 |
| Mailing Address: | 480 Central Ave, PEARL HARBOR |
| State: | HI |
| Postal Code: | 968604908 |
| Phone Number: | 8084731880 |
| Fax Number: | |
| NPI Enumeration Date: | 11/17/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 0024165406 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |