Provider Demographics
NPI:1598078479
Name:BENAVIDES, NATASHA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:
Last Name:BENAVIDES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:BEECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:812 GORMAN AVE
Mailing Address - Street 2:P.O. BOX 1484
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3181
Mailing Address - Country:US
Mailing Address - Phone:304-636-9012
Mailing Address - Fax:304-636-8966
Practice Address - Street 1:812 GORMAN AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3181
Practice Address - Country:US
Practice Address - Phone:304-636-9012
Practice Address - Fax:304-636-8966
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1494363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV0559BMedicare PIN