Healthcare Provider Details

I. General information

NPI: 1699154674
Provider Name (Legal Business Name): HOLLY BECKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY LAWSON

II. Dates (important events)

Enumeration Date: 05/25/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 CONCRETE RD
CARLISLE KY
40311-9700
US

IV. Provider business mailing address

209 N MAYSVILLE ST STE 200
MOUNT STERLING KY
40353-1179
US

V. Phone/Fax

Practice location:
  • Phone: 859-405-4025
  • Fax: 859-517-3014
Mailing address:
  • Phone: 859-404-7686
  • Fax: 859-498-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3009400
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: