Provider Demographics
NPI:1346445640
Name:BEEBOUT, CARRIE DEE (PA C)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:DEE
Last Name:BEEBOUT
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 1:323 BUDFIELD ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-6905
Mailing Address - Country:US
Mailing Address - Phone:814-262-9500
Mailing Address - Fax:814-262-7303
Practice Address - Street 1:323 BUDFIELD ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-6905
Practice Address - Country:US
Practice Address - Phone:814-262-9500
Practice Address - Fax:814-262-7303
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052969363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical