Healthcare Provider Details

I. General information

NPI: 1467654517
Provider Name (Legal Business Name): AUTUMN LORRAINE BEYER PA-C, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUTUMN HAMADY PA-C

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 MAIN ST 2ND FL
JOHNSTOWN PA
15901-1601
US

IV. Provider business mailing address

1086 FRANKLIN ST
JOHNSTOWN PA
15905-4305
US

V. Phone/Fax

Practice location:
  • Phone: 814-534-1095
  • Fax: 814-534-6145
Mailing address:
  • Phone: 814-410-8300
  • Fax: 814-410-8331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT004068
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: