Provider Demographics
NPI:1447852447
Name:BEVARD, MIRANDA KATELYN (PA-C)
Entity type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:KATELYN
Last Name:BEVARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:245 NEFF RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:PA
Mailing Address - Zip Code:15344-4210
Mailing Address - Country:US
Mailing Address - Phone:724-317-7642
Mailing Address - Fax:
Practice Address - Street 1:100 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:PA
Practice Address - Zip Code:15478-1650
Practice Address - Country:US
Practice Address - Phone:724-569-8100
Practice Address - Fax:724-569-8368
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061628363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical