Healthcare Provider Details

I. General information

NPI: 1306858659
Provider Name (Legal Business Name): DEBRA KAY BECKMAN FAMILY NURSE PRACT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA KAY BECKMAN FAMILY NURSE PRACT

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 W ADAMS ST
BOWLING GREEN MO
63334-1974
US

IV. Provider business mailing address

1015 W ADAMS ST
BOWLING GREEN MO
63334-1974
US

V. Phone/Fax

Practice location:
  • Phone: 573-324-5300
  • Fax: 573-324-6059
Mailing address:
  • Phone: 573-324-5300
  • Fax: 573-324-6059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number095887
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: