Provider Demographics
NPI:1154142388
Name:BECK, MIKEL NICHOLE (CRNP)
Entity type:Individual
Prefix:
First Name:MIKEL
Middle Name:NICHOLE
Last Name:BECK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426-1707
Mailing Address - Country:US
Mailing Address - Phone:251-868-2090
Mailing Address - Fax:251-868-2091
Practice Address - Street 1:711 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1707
Practice Address - Country:US
Practice Address - Phone:251-868-2090
Practice Address - Fax:251-868-2091
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3-001998208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics