Healthcare Provider Details

I. General information

NPI: 1215300264
Provider Name (Legal Business Name): BECK FAMILY MEDICAL CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 MARTY LN
HATTIEVILLE AR
72063-8930
US

IV. Provider business mailing address

PO BOX 6
HATTIEVILLE AR
72063-0006
US

V. Phone/Fax

Practice location:
  • Phone: 501-977-0102
  • Fax: 501-977-0120
Mailing address:
  • Phone: 501-977-0102
  • Fax: 501-977-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF0513126
License Number StateAR

VIII. Authorized Official

Name: NATAILLE C BECK
Title or Position: CERTIFIED NURSE PRACTIONER
Credential: APN
Phone: 501-977-0102