Provider Demographics
NPI:1013911346
Name:NEACE, BEVERLY PAIGE (PAC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:PAIGE
Last Name:NEACE
Suffix:
Gender:F
Credentials:PAC
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 1988
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702
Mailing Address - Country:US
Mailing Address - Phone:606-435-7643
Mailing Address - Fax:606-436-5282
Practice Address - Street 1:101 TOWN AND COUNTRY LN STE 100
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9524
Practice Address - Country:US
Practice Address - Phone:606-439-1300
Practice Address - Fax:606-439-1400
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA516363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0776320Medicare PIN
183918Medicare Oscar/Certification
183942Medicare Oscar/Certification
KYS85806Medicare UPIN
183947Medicare Oscar/Certification
0984409Medicare PIN
KY00712003Medicare PIN
KY183953Medicare Oscar/Certification
KY00051011Medicare PIN
KY1371425Medicare ID - Type Unspecified