Provider Demographics
NPI:1033222757
Name:BEATY, KAREN ANNETTE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ANNETTE
Last Name:BEATY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:BEATY
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4095
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02560363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194982801Medicaid
TX87N146OtherBLUE CROSS BLUE SHIELD
TX970027898OtherRAILROAD MEDICARE
TX87N146OtherBLUE CROSS BLUE SHIELD
TX83N427Medicare PIN