Provider Demographics
NPI:1023459831
Name:BEGAYE, PERNELL KEVIN
Entity type:Individual
Prefix:
First Name:PERNELL
Middle Name:KEVIN
Last Name:BEGAYE
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 998
Mailing Address - Street 2:
Mailing Address - City:ST MICHAELS
Mailing Address - State:AZ
Mailing Address - Zip Code:86511-0998
Mailing Address - Country:US
Mailing Address - Phone:928-797-4552
Mailing Address - Fax:
Practice Address - Street 1:1822B SOUTH OF ROUTE 12
Practice Address - Street 2:
Practice Address - City:ST MICHAELS
Practice Address - State:AZ
Practice Address - Zip Code:86511
Practice Address - Country:US
Practice Address - Phone:928-797-4552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD04660165343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)