Provider Demographics
NPI:1801404066
Name:BEAMAN, MICHELLE EVANS (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:EVANS
Last Name:BEAMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S DEKALB ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-6184
Mailing Address - Country:US
Mailing Address - Phone:704-480-1882
Mailing Address - Fax:704-480-1832
Practice Address - Street 1:615 S DEKALB ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-6184
Practice Address - Country:US
Practice Address - Phone:704-480-1882
Practice Address - Fax:704-480-1832
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant