Provider Demographics
NPI:1073030938
Name:BECKER, KATHRYN ANN (APN-FNP-BC, ACNPC-AG)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:BECKER
Suffix:
Gender:F
Credentials:APN-FNP-BC, ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12255 S 80TH AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1284
Mailing Address - Country:US
Mailing Address - Phone:708-923-5900
Mailing Address - Fax:708-923-8599
Practice Address - Street 1:12255 S 80TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1284
Practice Address - Country:US
Practice Address - Phone:708-923-5900
Practice Address - Fax:708-923-8599
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016329363LA2100X, 363LC0200X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209016329OtherADVANCED PRACTICE NURSE