Provider Demographics
NPI:1669194510
Name:BEAVERS, TAYLOR (PA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:BEAVERS
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 1:1187 SW 208TH PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-1539
Mailing Address - Country:US
Mailing Address - Phone:480-276-1454
Mailing Address - Fax:
Practice Address - Street 1:1610 12TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2821
Practice Address - Country:US
Practice Address - Phone:503-905-9006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant