Provider Demographics
NPI:1336287705
Name:GLASURE, BEVERLY KAY (PA)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:KAY
Last Name:GLASURE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 KINGSTON HWY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-5331
Mailing Address - Country:US
Mailing Address - Phone:865-717-1270
Mailing Address - Fax:
Practice Address - Street 1:820 W RACE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-2120
Practice Address - Country:US
Practice Address - Phone:865-376-3406
Practice Address - Fax:865-376-1559
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN085363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE01411Medicare UPIN
TNF43404Medicare UPIN
TNE67989Medicare UPIN
TNE86961Medicare UPIN
TNF63242Medicare UPIN
TNI29903Medicare UPIN
TNF66489Medicare UPIN
TNG38800Medicare UPIN
TNA98753Medicare UPIN