Healthcare Provider Details

I. General information

NPI: 1609234509
Provider Name (Legal Business Name): MEOSHE BECKWORTH PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5502 MARVIN SHIELDS BLVD
GULFPORT MS
39501
US

IV. Provider business mailing address

5502 MARVIN SHIELDS BLVD
GULFPORT MS
39501
US

V. Phone/Fax

Practice location:
  • Phone: 228-822-5767
  • Fax:
Mailing address:
  • Phone: 228-822-5767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-005731
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: