Healthcare Provider Details

I. General information

NPI: 1558900233
Provider Name (Legal Business Name): ATLENA ROSE BECKFORD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9103 LITTLE GREEN ST
TOMBALL TX
77375-2037
US

IV. Provider business mailing address

9103 LITTLE GREEN ST
TOMBALL TX
77375-2037
US

V. Phone/Fax

Practice location:
  • Phone: 301-655-8147
  • Fax:
Mailing address:
  • Phone: 301-655-8147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number736454
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: