MEDICARE: ANDREA C BEAVERS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA06332	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033349303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA C BEAVERS PA-C

Provider Business Mailing Address
First Line	:	6181 BONNIE VIEW RD STE 160
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-5149
Country	:	US
Telephone Number	:	214-374-0827
Fax Number	:	214-374-0927

Provider Business Practice Location Address
First Line	:	6181 BONNIE VIEW RD STE 160
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-5149
Country	:	US
Telephone Number	:	214-374-0827
Fax Number	:	214-374-0927

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	01/17/2024

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Directions to “ ANDREA C BEAVERS PA-C” Practice Location

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