Provider Demographics
NPI:1376573071
Name:BEAVERS, LANCIA S (FNP)
Entity Type:Individual
Prefix:MS
First Name:LANCIA
Middle Name:S
Last Name:BEAVERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LANCIA
Other - Middle Name:LOUISE
Other - Last Name:SCHREIBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 734812
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-4812
Mailing Address - Country:US
Mailing Address - Phone:210-358-9500
Mailing Address - Fax:210-358-9183
Practice Address - Street 1:3338 OAKWELL CT STE 160
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-3086
Practice Address - Country:US
Practice Address - Phone:210-644-4350
Practice Address - Fax:210-702-6978
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP45412Medicare UPIN
TX8L10721Medicare PIN