Provider Demographics
NPI:1083040984
Name:BEVIER, BECKI L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BECKI
Middle Name:L
Last Name:BEVIER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:BECKI
Other - Middle Name:L
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:459 N HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3924
Mailing Address - Country:US
Mailing Address - Phone:843-889-3870
Mailing Address - Fax:
Practice Address - Street 1:459 N HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3924
Practice Address - Country:US
Practice Address - Phone:843-889-3870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017035363A00000X
SC3580363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant