Provider Demographics
NPI:1215922620
Name:BEECHER, JOANN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:
Last Name:BEECHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:
Other - Last Name:GAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:608 UNION CHAPEL ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9357
Mailing Address - Country:US
Mailing Address - Phone:260-482-5091
Mailing Address - Fax:260-498-2029
Practice Address - Street 1:11109 PARKVIEW PLAZA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1701
Practice Address - Country:US
Practice Address - Phone:260-266-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000363A363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP04187Medicare UPIN
IN047840MMMMedicare ID - Type Unspecified
970017582Medicare ID - Type UnspecifiedRR MEDICARE