Provider Demographics
NPI:1346653128
Name:BECKHAM, DEVIN ASHLEIGH (PA-C)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:ASHLEIGH
Last Name:BECKHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEVIN
Other - Middle Name:ASHLEIGH
Other - Last Name:DEARING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8450 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1381
Practice Address - Country:US
Practice Address - Phone:317-802-2000
Practice Address - Fax:317-802-2170
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001680A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001342103OtherANTHEM PTAN
IN1102434108OtherANTHEM PTAN
INQ00265913OtherRAILROAD PTAN
IN000001342103Other1102434108
IN300006706Medicaid
IN000001342103Other1102434108