Provider Demographics
NPI:1962869313
Name:BEVERLY, PAIGE ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:ELIZABETH
Last Name:BEVERLY
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 1:13100 N WESTERN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-1432
Mailing Address - Country:US
Mailing Address - Phone:405-947-6647
Mailing Address - Fax:405-948-6647
Practice Address - Street 1:13100 N WESTERN AVE STE 301
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-1432
Practice Address - Country:US
Practice Address - Phone:405-947-6647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2646363A00000X, 363AM0700X
OKPA2646207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical