Provider Demographics
NPI:1245804988
Name:BEESE, HARLEY RICHARD (PA-C)
Entity Type:Individual
Prefix:
First Name:HARLEY
Middle Name:RICHARD
Last Name:BEESE
Suffix:
Gender:M
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 1:842 LOG SHOALS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5022
Mailing Address - Country:US
Mailing Address - Phone:419-503-5373
Mailing Address - Fax:
Practice Address - Street 1:120 PELHAM LN
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3335
Practice Address - Country:US
Practice Address - Phone:419-503-5373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3939363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant