Individual provider · NPI-1

Paige Elizabeth Beverly, PA-C

Dermatology · Oklahoma City, OK

NPI number1962869313

StatusActive

Last updated in NPPESOct 17, 2018

Details

NPI: 1962869313
Entity type: Individual (NPI-1)
Name: Paige Elizabeth Beverly
Credential: PA-C
Sex: Female
Sole proprietor: No
Enumeration date: Jan 15, 2016
Last updated: Oct 17, 2018

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207N00000X	Dermatology	PA2646	OK	Yes
363A00000X	Physician Assistant	2646	OK
363AM0700X	Physician Assistant, Medical	2646	OK

Practice location

13100 N Western Ave Ste 301
Oklahoma City, OK 73114-1432

Phone 405-947-6647

Mailing address

13100 N Western Ave Ste 301
Oklahoma City, OK 73114-1432

Phone 405-947-6647 · Fax 405-948-6647

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