Individual
MRS. AMIE DOUGHERTY BEALS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
140 W MAIN STREET, SUITE 100, SPRINGFIELD, OH 45502-1312
(937) 398-1066
(937) 398-1076
Mailing address
2905 KILKENNY DR, SPRINGFIELD, OH 45503-7104
(937) 418-8226
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50-00-1268
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0067790
—
OH
Enumeration date
09/15/2005
Last updated
01/28/2020
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