Provider Demographics
NPI:1033349303
Name:BEAVERS, ANDREA C (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:C
Last Name:BEAVERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6181 BONNIE VIEW RD STE 160
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-5149
Mailing Address - Country:US
Mailing Address - Phone:214-374-0827
Mailing Address - Fax:214-374-0927
Practice Address - Street 1:6181 BONNIE VIEW RD STE 160
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-5149
Practice Address - Country:US
Practice Address - Phone:214-374-0827
Practice Address - Fax:214-374-0927
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06332363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205082501Medicaid
TX205082502Medicaid
TX205082503Medicaid
TX8L18189Medicare PIN
TX8L18191Medicare PIN
TX205082502Medicaid