Provider Demographics
NPI:1629769708
Name:BEAMESDERFER, KOURTNEY (PA)
Entity Type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:
Last Name:BEAMESDERFER
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 1:183 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16872-9107
Mailing Address - Country:US
Mailing Address - Phone:814-571-0121
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1440
Practice Address - Country:US
Practice Address - Phone:814-371-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant