Healthcare Provider Details

I. General information

NPI: 1225436157
Provider Name (Legal Business Name): KATIE L BECKMANN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 CHASE AVE
CREIGHTON NE
68729-2893
US

IV. Provider business mailing address

PO BOX 110
CREIGHTON NE
68729-0110
US

V. Phone/Fax

Practice location:
  • Phone: 402-358-5335
  • Fax: 402-358-3598
Mailing address:
  • Phone: 402-358-5335
  • Fax: 402-358-3598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1909
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: