Healthcare Provider Details

I. General information

NPI: 1285199075
Provider Name (Legal Business Name): KARA BECKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 EXCELSIOR BLVD
MINNEAPOLIS MN
55426-4702
US

IV. Provider business mailing address

6500 EXCELSIOR BLVD
ST LOUIS PARK MN
55426-4702
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-1000
  • Fax:
Mailing address:
  • Phone: 952-993-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12916
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: