Provider Demographics
NPI:1568467165
Name:NORMENT, REBECCA BEAVER (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:BEAVER
Last Name:NORMENT
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 1:1055 CLARKSVILLE ST
Mailing Address - Street 2:STE 195
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-6097
Mailing Address - Country:US
Mailing Address - Phone:903-785-8480
Mailing Address - Fax:903-785-8455
Practice Address - Street 1:1055 CLARKSVILLE ST
Practice Address - Street 2:STE 195
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-6097
Practice Address - Country:US
Practice Address - Phone:903-785-8480
Practice Address - Fax:903-785-8455
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03704363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100071470AMedicaid
TX100280005Medicaid
TX00TU80OtherBLUE CROSS BLUE SHILED
TX020003359OtherMEDICARE RAILROAD
TX020003359OtherMEDICARE RAILROAD
TX8A5124Medicare PIN