Provider Demographics
NPI:1750506382
Name:BEGAY, JERRY LEE
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:LEE
Last Name:BEGAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:AZ
Mailing Address - Zip Code:86025-0636
Mailing Address - Country:US
Mailing Address - Phone:602-363-4901
Mailing Address - Fax:
Practice Address - Street 1:2.5 MI WEST MP 0 NAVAJO ROUTE 5
Practice Address - Street 2:
Practice Address - City:INDIAN WELL
Practice Address - State:AZ
Practice Address - Zip Code:86031-0636
Practice Address - Country:US
Practice Address - Phone:602-363-4901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered372500000XNursing Service Related ProvidersChore Provider
Not Answered372600000XNursing Service Related ProvidersAdult Companion
Not Answered3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Not Answered374U00000XNursing Service Related ProvidersHome Health Aide
Not Answered376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ630203OtherAHCCCS PROVIDER ID NUMBER