Provider Demographics
NPI:1164729737
Name:BELTON, JUANITA DIANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:DIANNE
Last Name:BELTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JUANITA
Other - Middle Name:DIANNE
Other - Last Name:HOBBS-KENNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:801 ALBANY ST FL G
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-3791
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:830 HARRISON AVE FL
Practice Address - Street 2:MOAKLEY STE 3500
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-6525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4126363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110122852AMedicaid