Provider Demographics
NPI:1427138981
Name:BECK, AMBER LEIGH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LEIGH
Last Name:BECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-9007
Mailing Address - Country:US
Mailing Address - Phone:417-875-3462
Mailing Address - Fax:
Practice Address - Street 1:1001 E PRIMROSE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5155
Practice Address - Country:US
Practice Address - Phone:417-875-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005003650363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220024600Medicaid
MO2005003650OtherMISSOURI LICENSE
MOMA2082224Medicare PIN
MO000097289Medicare PIN
MO132300044Medicare PIN
MO599460508Medicaid
431560263OtherTRICARE WEST
P00653970OtherRAILROAD MEDICARE
OK200407090AMedicaid
KS200739830AMedicaid
MO132680038Medicare PIN
MOMA3446196Medicare PIN