Provider Demographics
NPI:1598355034
Name:BEAUCHAMP, VALERIA (PA)
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 HUNTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-8420
Mailing Address - Country:US
Mailing Address - Phone:865-765-9465
Mailing Address - Fax:
Practice Address - Street 1:1220 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-8420
Practice Address - Country:US
Practice Address - Phone:865-765-9465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4245363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant