Provider Demographics
NPI:1689665887
Name:BEAVER, GAIL LYNN (NP)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:LYNN
Last Name:BEAVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7541 US HIGHWAY 87 E,
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78263
Mailing Address - Country:US
Mailing Address - Phone:210-648-9900
Mailing Address - Fax:210-648-5602
Practice Address - Street 1:7541 US HIGHWAY 87 E,
Practice Address - Street 2:SUITE #1
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78263
Practice Address - Country:US
Practice Address - Phone:210-648-9900
Practice Address - Fax:210-648-9902
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP114117363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177707001Medicaid
TX8G0478Medicare PIN
TXQ53730Medicare UPIN