Provider Demographics
NPI:1538416219
Name:BESHORE, KELLY EURICH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:EURICH
Last Name:BESHORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:EURICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:225 GRANDVIEW AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1729
Mailing Address - Country:US
Mailing Address - Phone:717-988-8200
Mailing Address - Fax:717-221-5644
Practice Address - Street 1:225 GRANDVIEW AVE STE 303
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1729
Practice Address - Country:US
Practice Address - Phone:717-988-8200
Practice Address - Fax:717-221-5644
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000837363A00000X
PAMA055561363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant