Healthcare Provider Details

I. General information

NPI: 1922457886
Provider Name (Legal Business Name): KATHERINE BECKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE RABE

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 04/07/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 COWAN DRIVE
LEBANON MO
65536
US

IV. Provider business mailing address

PO BOX 505164
SAINT LOUIS MO
63150-5164
US

V. Phone/Fax

Practice location:
  • Phone: 417-532-2805
  • Fax: 417-532-2848
Mailing address:
  • Phone: 417-829-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2006022442
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016019527
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: