Provider Demographics
NPI:1215300264
Name:BECK FAMILY MEDICAL CLINIC PLLC
Entity type:Organization
Organization Name:BECK FAMILY MEDICAL CLINIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:NATAILLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:501-977-0102
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:HATTIEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72063-0006
Mailing Address - Country:US
Mailing Address - Phone:501-977-0102
Mailing Address - Fax:501-977-0120
Practice Address - Street 1:38 MARTY LN
Practice Address - Street 2:
Practice Address - City:HATTIEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72063-8930
Practice Address - Country:US
Practice Address - Phone:501-977-0102
Practice Address - Fax:501-977-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARF0513126363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1629418553OtherPROVIDER NPI
AR198622758Medicaid