Provider Demographics
NPI:1801182258
Name:BEEBE, SADIE MCCALLISTER (PA-C)
Entity Type:Individual
Prefix:
First Name:SADIE
Middle Name:MCCALLISTER
Last Name:BEEBE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SADIE
Other - Middle Name:M
Other - Last Name:SCHURMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7925 YOUREE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5127
Mailing Address - Country:US
Mailing Address - Phone:318-424-3400
Mailing Address - Fax:
Practice Address - Street 1:7925 YOUREE DR STE 220
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5134
Practice Address - Country:US
Practice Address - Phone:318-212-3610
Practice Address - Fax:318-212-3709
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA200455363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2155644Medicaid