Jordan S Bevan, PA-C
Physician Assistant in Fresno, CA. Individual provider (NPI-1).
NPI number1124577408
StatusActive
Last updated in NPPESJan 3, 2022
Details
- NPI
- 1124577408
- Entity type
- Individual (NPI-1)
- Name
- Jordan S Bevan
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 27, 2016
- Last updated
- Jan 3, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 53854 | CA | Yes |
Practice location
45 E River Park Pl WFresno, CA 93720-1562
Phone 559-320-0530 · Fax 559-320-0532
Mailing address
2625 E Divisadero StFresno, CA 93721-1431
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 194 Physician Assistant providers in Fresno · All 23,426 providers in Fresno
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