Provider Demographics
NPI:1396704524
Name:BECKETT, TERESA M (ARNP, PA-C)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:M
Last Name:BECKETT
Suffix:
Gender:F
Credentials:ARNP, PA-C
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Mailing Address - Street 1:611 SOUTH CHESTNUT
Mailing Address - Street 2:SUITE D
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-4815
Mailing Address - Country:US
Mailing Address - Phone:509-933-8700
Mailing Address - Fax:509-933-8705
Practice Address - Street 1:611 SOUTH CHESTNUT
Practice Address - Street 2:SUITE D
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-4815
Practice Address - Country:US
Practice Address - Phone:509-933-8700
Practice Address - Fax:509-933-8705
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-05-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPA10003395363A00000X
WAAP3002067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7831308Medicaid
WA69411Medicare PIN
WA503878Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC ID #
WAP54494Medicare UPIN