Provider Demographics
NPI:1487817110
Name:THOMAS, BEENA (PA-C)
Entity Type:Individual
Prefix:
First Name:BEENA
Middle Name:
Last Name:THOMAS
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 98820
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8820
Mailing Address - Country:US
Mailing Address - Phone:702-914-7150
Mailing Address - Fax:702-492-1728
Practice Address - Street 1:10410 S EASTERN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4195
Practice Address - Country:US
Practice Address - Phone:702-914-7150
Practice Address - Fax:702-492-1728
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA725363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVBH5432Medicare PIN