Iltis, Beverly K
Iltis, Beverly K is an individual health care provider with primary practice located at 805 Medical Dr , Longview TX 75605-5130. 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. Iltis, Beverly K can be contacted via phone (903) 757-6042.Contact Information
Primary practice address
805 Medical Dr
Longview TX 75605-5130
Phone: (903) 757-6042
Fax: (903) 291-6138
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA02521 | Texas |
Profile Details
| NPI number | 1326015074 |
|---|---|
| LBN Legal business name | Iltis, Beverly K |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 1st, 2006 |
| Last updated | Nov 11th, 2021 - about 3 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1326015074 | NPPES |
| Texas | MEDICAID | 286521406 |
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