Provider Demographics
NPI:1225434798
Name:BEEDLES, MOLLY JEAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:JEAN
Last Name:BEEDLES
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:PO BOX 10722
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97296-0722
Mailing Address - Country:US
Mailing Address - Phone:503-684-8252
Mailing Address - Fax:
Practice Address - Street 1:3939 SW BOND AVE
Practice Address - Street 2:APT. 209
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4706
Practice Address - Country:US
Practice Address - Phone:785-331-6145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA59660363A00000X
ORPA174934363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant