Provider Demographics
NPI:1295817856
Name:BEDDINGFIELD, DONNA SHEREE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:SHEREE
Last Name:BEDDINGFIELD
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 849
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201
Mailing Address - Country:US
Mailing Address - Phone:719-539-4600
Mailing Address - Fax:719-539-4629
Practice Address - Street 1:925 RUSH DR
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201
Practice Address - Country:US
Practice Address - Phone:719-539-4600
Practice Address - Fax:719-539-4629
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2280363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COQ77251Medicare UPIN
COCK1808Medicare PIN