Healthcare Provider Details

I. General information

NPI: 1356764476
Provider Name (Legal Business Name): KAREN G BECKMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 3RD AVE
JASPER IN
47546-3602
US

IV. Provider business mailing address

695 3RD AVE
JASPER IN
47546-3602
US

V. Phone/Fax

Practice location:
  • Phone: 812-634-6824
  • Fax: 812-481-1056
Mailing address:
  • Phone: 812-634-6824
  • Fax: 812-481-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004779A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28096845A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: