Healthcare Provider Details

I. General information

NPI: 1457724726
Provider Name (Legal Business Name): JENNIFER BECKER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2015
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 HERMIT LANE
WESTCLIFFE CO
81252
US

IV. Provider business mailing address

746 COUNTY ROAD 129
WESTCLIFFE CO
81252-9309
US

V. Phone/Fax

Practice location:
  • Phone: 719-204-5137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0992044
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: