Provider Demographics
NPI:1154367159
Name:SPRINGSTEAD, BEVERLEY JEAN (PA)
Entity type:Individual
Prefix:MS
First Name:BEVERLEY
Middle Name:JEAN
Last Name:SPRINGSTEAD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:BEVERLEY
Other - Middle Name:JEAN
Other - Last Name:PEAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:618 N JEFFERSON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-3647
Mailing Address - Country:US
Mailing Address - Phone:903-575-9500
Mailing Address - Fax:903-575-9866
Practice Address - Street 1:618 N JEFFERSON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-3647
Practice Address - Country:US
Practice Address - Phone:903-575-9500
Practice Address - Fax:903-575-9866
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03750363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182504401Medicaid
TXQ15902Medicare UPIN
TX182504401Medicaid