Individual
MRS. BEVERLY LORRAINE TASCHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1525 MADISON ST, STE 2, FREDONIA, KS 66736-1704
(620) 378-2068
(620) 378-2312
Mailing address
1525 MADISON ST, STE 2, FREDONIA, KS 66736-1704
(620) 378-2068
(620) 378-2312
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1500290
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000427259
BLUE CROSS BLUE SHIELD OF KANSAS
KS
05
—
100003170C
—
KS
Enumeration date
08/30/2005
Last updated
01/04/2010
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