Provider Demographics
NPI:1487369641
Name:BECKSTEAD, AMELIA JEAN (RN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:JEAN
Last Name:BECKSTEAD
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:JEAN
Other - Last Name:SOUTHWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:72 N 420 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4994
Mailing Address - Country:US
Mailing Address - Phone:801-368-0690
Mailing Address - Fax:
Practice Address - Street 1:1606 23RD AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-6407
Practice Address - Country:US
Practice Address - Phone:907-455-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK215323363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Single Specialty