Healthcare Provider Details

I. General information

NPI: 1295817856
Provider Name (Legal Business Name): DONNA SHEREE BEDDINGFIELD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 RUSH DR
SALIDA CO
81201
US

IV. Provider business mailing address

PO BOX 849
SALIDA CO
81201
US

V. Phone/Fax

Practice location:
  • Phone: 719-539-4600
  • Fax: 719-539-4629
Mailing address:
  • Phone: 719-539-4600
  • Fax: 719-539-4629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2280
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: