Provider Demographics
NPI:1639290323
Name:BEASLEY, SIDNEY MAX II (ANP)
Entity type:Individual
Prefix:MR
First Name:SIDNEY
Middle Name:MAX
Last Name:BEASLEY
Suffix:II
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1065
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-1065
Mailing Address - Country:US
Mailing Address - Phone:479-725-3000
Mailing Address - Fax:479-725-3098
Practice Address - Street 1:4001 WAGON WHEEL RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0137
Practice Address - Country:US
Practice Address - Phone:479-725-3000
Practice Address - Fax:479-725-3098
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP78622Medicare UPIN