Provider Demographics
NPI:1447444948
Name:PRESCOTT, KIA BEVERLY (PA-C)
Entity type:Individual
Prefix:
First Name:KIA
Middle Name:BEVERLY
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44 BINNEY ST
Mailing Address - Street 2:SUITE D1210
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6013
Mailing Address - Country:US
Mailing Address - Phone:617-632-6318
Mailing Address - Fax:617-632-3479
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:SUITE D1210
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6013
Practice Address - Country:US
Practice Address - Phone:617-632-6318
Practice Address - Fax:617-632-3479
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAAP2380363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant