Provider Demographics
NPI:1902876246
Name:BEAVERS, MARLA D (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:D
Last Name:BEAVERS
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 1:750 EUREKA ST STE A
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6521
Mailing Address - Country:US
Mailing Address - Phone:817-405-2689
Mailing Address - Fax:817-405-2689
Practice Address - Street 1:750 EUREKA ST STE A
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6521
Practice Address - Country:US
Practice Address - Phone:817-550-6073
Practice Address - Fax:817-550-6076
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0001291363A00000X
TXPA01721363AM0700X, 363A00000X
CA54554363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical