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NPI Code Detail

MEDICARE: KEVIN BEAVER

MEDICARE: KEVIN BEAVER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant2637OK

General Provider Information

NPI Number : 1528426442
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN BEAVER
Provider Business Mailing Address
First Line : 430 N MONTE VISTA ST
Second Line :
City : ADA
State : OK
Zip : 74820-4610
Country : US
Telephone Number : 580-421-1127
Fax Number : 580-436-6674
Provider Business Practice Location Address
First Line : 430 N MONTE VISTA ST
Second Line :
City : ADA
State : OK
Zip : 74820-4610
Country : US
Telephone Number : 580-421-1127
Fax Number : 580-436-6674
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2016
Last Update Date : 03/10/2026

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Directions to “ KEVIN BEAVER ” Practice Location

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