Provider Demographics
NPI:1649360108
Name:STUART, BEVERLY JEAN (PA-C)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:JEAN
Last Name:STUART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:BEVERLY
Other - Middle Name:JEAN
Other - Last Name:GUTHRIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2301 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-3976
Mailing Address - Country:US
Mailing Address - Phone:903-278-3879
Mailing Address - Fax:
Practice Address - Street 1:4001 LEOPARD DR
Practice Address - Street 2:HEALTH SERVICES
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503
Practice Address - Country:US
Practice Address - Phone:903-838-4587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01831363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP42543Medicare UPIN