Provider Demographics
NPI:1700138799
Name:BEVERLIN, JOHN ANDREW (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANDREW
Last Name:BEVERLIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 FENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-2116
Mailing Address - Country:US
Mailing Address - Phone:713-922-4482
Mailing Address - Fax:
Practice Address - Street 1:211 HIGHLAND CROSS DR STE 275
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-1741
Practice Address - Country:US
Practice Address - Phone:281-784-3203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXPA08033363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1700138799OtherTRICARE
TX313597201Medicaid
TX313597202Medicaid
TX890N67OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX760555765OtherUNITED HEALTH CARE
TX313597201Medicaid
TX261641YK81Medicare PIN