Provider Demographics
NPI:1477352920
Name:BECK, KELSEY MARISA
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARISA
Last Name:BECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 SYCAMORE PL
Mailing Address - Street 2:
Mailing Address - City:HICKMAN
Mailing Address - State:NE
Mailing Address - Zip Code:68372-9520
Mailing Address - Country:US
Mailing Address - Phone:402-770-3307
Mailing Address - Fax:
Practice Address - Street 1:245 SYCAMORE PL
Practice Address - Street 2:
Practice Address - City:HICKMAN
Practice Address - State:NE
Practice Address - Zip Code:68372-9520
Practice Address - Country:US
Practice Address - Phone:402-770-3307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant