NPI 1124669643 · live from the CMS NPI Registry
Jordan Beasley
Physician Assistant in Rockville, MD. National Provider Identifier 1124669643, active.
NPI record
| NPI | 1124669643 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 9901 Medical Center Dr, Rockville, MD 20850 |
| Practice phone | 240-826-6000 |
| Mailing address | 1923 S Utica Ave, Tulsa, OK 74104 |
| Enumerated | October 6, 2019 |
| Last updated | October 31, 2025 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant primary | 363A00000X | 3138 (OK) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.