Healthcare Provider Details

I. General information

NPI: 1215175732
Provider Name (Legal Business Name): BRIGETTE N BEVLY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 COLUMBIA RD STE 200
WESTLAKE OH
44145
US

IV. Provider business mailing address

850 COLUMBIA RD STE 200
WESTLAKE OH
44145-7215
US

V. Phone/Fax

Practice location:
  • Phone: 440-808-1212
  • Fax: 440-808-0321
Mailing address:
  • Phone: 440-808-1212
  • Fax: 440-808-0321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50002849
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: