1598916330 NPI number — WILLARD W. BEARD PA-C

Table of content: WILLARD W. BEARD PA-C (NPI 1598916330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598916330 NPI number — WILLARD W. BEARD PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEARD
Provider First Name:
WILLARD
Provider Middle Name:
W.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598916330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 MONROE HWY
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
PINEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71360-8110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-640-3737
Provider Business Mailing Address Fax Number:
318-640-3740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 MONROE HWY
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
PINEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71360-8110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-640-3737
Provider Business Practice Location Address Fax Number:
318-640-3740
Provider Enumeration Date:
10/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA A10447 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com