Provider Demographics
NPI:1538535984
Name:BEATTY, TINA (PA)
Entity type:Individual
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First Name:TINA
Middle Name:
Last Name:BEATTY
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Gender:F
Credentials:PA
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Mailing Address - Street 1:97 GREAT TEAYS BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9816
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:304-201-5019
Practice Address - Street 1:12 KANAWHA TER
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2750
Practice Address - Country:US
Practice Address - Phone:304-201-1130
Practice Address - Fax:304-201-1134
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2024-01-03
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Provider Licenses
StateLicense IDTaxonomies
OH50.004403363A00000X
WV712363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant