Provider Demographics
NPI:1306858659
Name:BECKMAN, DEBRA KAY (FAMILY NURSE PRACT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACT
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:KAY
Other - Last Name:BECKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FAMILY NURSE PRACT
Mailing Address - Street 1:1015 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:MO
Mailing Address - Zip Code:63334-1974
Mailing Address - Country:US
Mailing Address - Phone:573-324-5300
Mailing Address - Fax:573-324-6059
Practice Address - Street 1:1015 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-1974
Practice Address - Country:US
Practice Address - Phone:573-324-5300
Practice Address - Fax:573-324-6059
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO095887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P83437Medicare UPIN
MO000081474Medicare ID - Type Unspecified