Provider Demographics
NPI:1841261195
Name:BEAIRD, TERA L (PA-C)
Entity type:Individual
Prefix:
First Name:TERA
Middle Name:L
Last Name:BEAIRD
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:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:1150 STATE HIGHTWAY 248
Practice Address - Street 2:STE 200
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-4186
Practice Address - Country:US
Practice Address - Phone:417-336-4112
Practice Address - Fax:417-335-4684
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022009849363A00000X
MO2008015428363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO144790004Medicare PIN
MO144790004Medicare PIN
NVV108344Medicare PIN