Beverly, Lara Jennifer

Beverly, Lara Jennifer is an individual health care provider with primary practice located at 1339 S Broadway St , Sulphur Springs TX 75482-4895. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Beverly, Lara Jennifer can be contacted via phone (903) 951-1001.

Contact Information

Primary practice address
1339 S Broadway St Sulphur Springs TX 75482-4895
Phone: (903) 951-1001
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA05919 Texas

Profile Details

NPI number 1316199003
LBN Legal business name Beverly, Lara Jennifer
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 14th, 2008
Last updated Mar 23rd, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316199003 NPPES
Texas MEDICAID 210066104
Texas MEDICAID 210066106
Texas Other 8Y9005

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