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General NPI Number Information
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NPI Number | 1205378098
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Entity Type | Individual
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Provider Name | JACOB RAY BECK CRNA
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Gender | Male
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Dates
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Enumeration Date | 11/09/2016
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Last Update Date | 07/06/2020
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Provider Practice Location Address
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Address Line | 1600 WALLACE BLVD
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City | AMARILLO
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State | TX
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Zip | 79106-1799
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Country | US
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Telephone | 806-212-2000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 840853
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City | DALLAS
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State | TX
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Zip | 75284-2502
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Country | US
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Telephone | 972-715-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN664861
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 912946
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 116076
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP133544
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License Number State | TX
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