Provider Demographics
NPI:1194171009
Name:BACHOUR, BEATRICE FATIMA (PA-C)
Entity type:Individual
Prefix:
First Name:BEATRICE
Middle Name:FATIMA
Last Name:BACHOUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 GREEN CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:HENNING
Mailing Address - State:TN
Mailing Address - Zip Code:38041-5726
Mailing Address - Country:US
Mailing Address - Phone:731-738-5044
Mailing Address - Fax:
Practice Address - Street 1:480 GREEN CHAPEL RD
Practice Address - Street 2:
Practice Address - City:HENNING
Practice Address - State:TN
Practice Address - Zip Code:38041-5726
Practice Address - Country:US
Practice Address - Phone:731-738-5044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3002363AM0700X
MI5601007739363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical