Beverly Lavon McNeil, PAC
Individual provider Active NPI Physician Assistant · Forks, WA
NPI 1255470100 · NPPES record last updated Jun 15, 2011
Key facts
- NPI
- 1255470100
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA10004657 (WA)
- Practice address
- 530 Bogachiel Way
Forks, WA 98331-9120 - Phone
- (360) 374-6271
- Fax
- (360) 374-6238
- NPI assigned
- Feb 6, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA10004657 | WA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pacific Medical Group, PC | Past | Accepting new patients |
Interoperability endpoints
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.61288
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA10004657 | WA | Yes |
Addresses
Primary practice location
530 Bogachiel Way
Forks, WA 98331-9120
Mailing address
1265 Eddy St
Port Townsend, WA 98368-9216
Phone (360) 385-9730
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2334MC | Other | WA | REGENCE |
| 8389975 | Medicaid | WA | |
| 0188321 | Other | WA | L&I |
Other providers in Forks, WA
- Tytti Sinikka Lilja-Williams
- Lisa Ann Martinez
- Jay D Matsen
- Kathy A Matsen
- Debra Kay McIntyre
- Jessica Lee Mishler
- Reece Moody
- Kevin Ray Mooney
- Ken Morris
- Sarah Morrison
All providers in Forks, WA · Physician Assistant in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.