Provider Demographics
NPI:1104862788
Name:BEAN, JAMES R (APA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:BEAN
Suffix:
Gender:M
Credentials:APA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 DUNRAVEN CT
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29527-3154
Mailing Address - Country:US
Mailing Address - Phone:843-438-4876
Mailing Address - Fax:
Practice Address - Street 1:1013 DUNRAVEN CT
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29527-3154
Practice Address - Country:US
Practice Address - Phone:843-438-4876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1008159OtherNCCPA