Provider Demographics
NPI:1932298361
Name:POWELL, BEVERLY C (PA)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:C
Last Name:POWELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2087 FOUNTAINVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-4107
Mailing Address - Country:US
Mailing Address - Phone:850-494-0000
Mailing Address - Fax:850-494-0001
Practice Address - Street 1:5028 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2345
Practice Address - Country:US
Practice Address - Phone:850-494-0000
Practice Address - Fax:850-494-0001
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103114363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q35598Medicare UPIN