Healthcare Provider Details

I. General information

NPI: 1114622024
Provider Name (Legal Business Name): BECKY CROSS CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. BECKY BYERS

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 OLD LAFAYETTE RD
FORT OGLETHORPE GA
30742-3510
US

IV. Provider business mailing address

255 BROCK RD
MC DONALD TN
37353-5831
US

V. Phone/Fax

Practice location:
  • Phone: 706-866-5520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberGAA-NP003498
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: