Provider Demographics
NPI:1427364926
Name:BEAUCHAMP, REBECCA LOU (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LOU
Last Name:BEAUCHAMP
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 1:10081 FREDERICKSBURG RD NW
Mailing Address - Street 2:
Mailing Address - City:DEPAUW
Mailing Address - State:IN
Mailing Address - Zip Code:47115-8629
Mailing Address - Country:US
Mailing Address - Phone:812-347-2568
Mailing Address - Fax:812-347-2568
Practice Address - Street 1:10081 FREDERICKSBURG RD NW
Practice Address - Street 2:
Practice Address - City:DEPAUW
Practice Address - State:IN
Practice Address - Zip Code:47115-8629
Practice Address - Country:US
Practice Address - Phone:812-347-2568
Practice Address - Fax:812-347-2568
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZC0007X
KYPA2599363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant