Provider Demographics
NPI:1982310835
Name:MCBEATH, EMILY EILEEN
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:EILEEN
Last Name:MCBEATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:EILEEN
Other - Last Name:LEDFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12783 N 1500 EAST RD
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-3404
Mailing Address - Country:US
Mailing Address - Phone:815-992-9290
Mailing Address - Fax:
Practice Address - Street 1:1506 W REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-9674
Practice Address - Country:US
Practice Address - Phone:815-844-6123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant