Provider Demographics
NPI:1801503958
Name:BEAVERS, BRIDGETT GAY
Entity type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:GAY
Last Name:BEAVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2538 MCCOY RD
Mailing Address - Street 2:
Mailing Address - City:PEEBLES
Mailing Address - State:OH
Mailing Address - Zip Code:45660-9648
Mailing Address - Country:US
Mailing Address - Phone:740-493-1555
Mailing Address - Fax:
Practice Address - Street 1:8515 STATE ROUTE 124
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:OH
Practice Address - Zip Code:45646-9014
Practice Address - Country:US
Practice Address - Phone:740-493-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant