MEDICARE: COURTNEY DAWN BECK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	114566	OK

General Provider Information

NPI Number	:	1063069227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY DAWN BECK

Provider Business Mailing Address
First Line	:	609 VIRGINIA AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-2911
Country	:	US
Telephone Number	:	580-767-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 VIRGINIA AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-2911
Country	:	US
Telephone Number	:	580-767-1300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2019
Last Update Date	:	08/22/2019

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