Provider Demographics
NPI:1710952643
Name:PERRY, BEVERLY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9107 STATEN ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9672
Mailing Address - Country:US
Mailing Address - Phone:559-410-5328
Mailing Address - Fax:
Practice Address - Street 1:6401 TRUXTUN AVE
Practice Address - Street 2:STE
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0613
Practice Address - Country:US
Practice Address - Phone:661-327-9300
Practice Address - Fax:661-327-9301
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14634363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PA14634Medicaid
CA00PA14634Medicaid
P21742Medicare UPIN