Provider Demographics
NPI:1285892380
Name:BECKHAM, TRACY L (CRNA)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:L
Last Name:BECKHAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1103 E MONTCLAIR ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5076
Mailing Address - Country:US
Mailing Address - Phone:417-447-2482
Mailing Address - Fax:417-447-2596
Practice Address - Street 1:1103 E MONTCLAIR ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5076
Practice Address - Country:US
Practice Address - Phone:417-447-2482
Practice Address - Fax:417-447-2596
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO096072367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered