MEDICARE: MARY LEE BECK NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP5580	AZ
2	363LF0000X	Family Nurse Practitioner	AP5580	AZ

General Provider Information

NPI Number	:	1629327010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LEE BECK NP

Provider Business Mailing Address
First Line	:	2501 N STOCKTON HILL RD STE 108
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86401-4140
Country	:	US
Telephone Number	:	928-255-5050
Fax Number	:	888-571-5897

Provider Business Practice Location Address
First Line	:	2501 N STOCKTON HILL RD STE 108
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86401-4140
Country	:	US
Telephone Number	:	928-255-5050
Fax Number	:	888-571-5897

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2012
Last Update Date	:	08/26/2024

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