MEDICARE: MS. KELSEY SUE BEZNER

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1316584337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELSEY SUE BEZNER

Provider Business Mailing Address
First Line	:	2614 TAYLOR LN
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77581-5748
Country	:	US
Telephone Number	:	832-231-5120
Fax Number	:

Provider Business Practice Location Address
First Line	:	8558 CREEKSIDE FOREST DR BLDG B
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77375-2175
Country	:	US
Telephone Number	:	832-534-7700
Fax Number	:

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

Provider Enumeration Date	:	12/09/2019
Last Update Date	:	12/09/2019

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