Marla D Beavers, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA01721 Issued in TX

Practice address

750 Eureka St Ste a
Weatherford, TX 76086-6521

Phone

(817) 550-6073

Fax

(817) 550-6076

NPI assigned

Jan 26, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Montrose Dermatology PLLC

  • Dermatology Physician
  • Montrose, CO
  • NPI 1154613016
  NPD (past)
• Montrose Dermatology PLLC

  • Dermatology Physician
  • Gunnison, CO
  • NPI 1497328538
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660780800000",
    "number": "1902876246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 EUREKA ST STE A",
            "city": "WEATHERFORD",
            "state": "TX",
            "postal_code": "760866521",
            "telephone_number": "817-405-2689",
            "fax_number": "817-405-2689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 EUREKA ST STE A",
            "city": "WEATHERFORD",
            "state": "TX",
            "postal_code": "760866521",
            "telephone_number": "817-550-6073",
            "fax_number": "817-550-6076"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10509 Stonehill Dr",
            "address_purpose": "LOCATION",
            "city": "Benbrook",
            "state": "TX",
            "postal_code": "761264548",
            "country_code": "US",
            "telephone_number": "210-557-7288",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEAVERS",
        "first_name": "MARLA",
        "middle_name": "D",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-26",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA0001291",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA01721",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "54554",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA01721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Baylor Scott & White Surgicare at Weatherford LLC
• Civanna Jasmine Beam
• Erika Bean, FNP
• Whitney Marie Beard Akins
• Katherine Beard, DC
• Mikeal Dwain Beck, CP,LPO
• Paul Dwight Beery, MD
• Megan Bell
• Ben Combs Optical
• Kayla Bennett

• Physician Assistant in Weatherford, TX
• Providers in Weatherford, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.