Healthcare Provider Details

I. General information

NPI: 1457670150
Provider Name (Legal Business Name): STACY LEE BECK FNP, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY LEE HESSIAN RN, BSN

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15765 KINGSLEY RD
NINILCHIK AK
99639-9759
US

IV. Provider business mailing address

PO BOX 39368
NINILCHIK AK
99639-0368
US

V. Phone/Fax

Practice location:
  • Phone: 907-567-3970
  • Fax: 907-567-9002
Mailing address:
  • Phone: 907-567-3970
  • Fax: 79-567-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number29122
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number183312
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: