Provider Demographics
NPI:1811263015
Name:OPPER, BECKY L (PA)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:L
Last Name:OPPER
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 1:4724 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2339
Mailing Address - Country:US
Mailing Address - Phone:850-696-4000
Mailing Address - Fax:850-444-7057
Practice Address - Street 1:780 SWIFT BLVD STE 201
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3524
Practice Address - Country:US
Practice Address - Phone:509-942-3070
Practice Address - Fax:509-942-3167
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA65290363A00000X
WAPA1485985363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0A7AOtherBCBS FL
FL004956800Medicaid
FLP01040064OtherRAILROAD MCR
FL004956800Medicaid
FLY0A7AOtherBCBS FL
FLP999097OtherFREEDOM HEALTH
FLP940205OtherOPTIMUM