Provider Demographics
NPI:1700802410
Name:PARROTT, BEVERLY FAYTHE (PAC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:FAYTHE
Last Name:PARROTT
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 1:1867 AIRPORT WAY STE 140A
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4055
Mailing Address - Country:US
Mailing Address - Phone:907-457-9355
Mailing Address - Fax:907-457-9356
Practice Address - Street 1:1867 AIRPORT WAY STE 140A
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4055
Practice Address - Country:US
Practice Address - Phone:907-457-9355
Practice Address - Fax:907-457-9356
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK298363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKR85406Medicare UPIN
AK151732Medicare ID - Type Unspecified