Healthcare Provider Details

I. General information

NPI: 1528750932
Provider Name (Legal Business Name): LORA ROSE BEBERMEYER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 08/09/2025
Certification Date: 08/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 AYLWARD AVE
ELLSWORTH KS
67439-2541
US

IV. Provider business mailing address

1604 AYLWARD AVE
ELLSWORTH KS
67439-2541
US

V. Phone/Fax

Practice location:
  • Phone: 785-810-1177
  • Fax: 785-472-5760
Mailing address:
  • Phone: 785-810-1177
  • Fax: 785-472-5760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: