MEDICARE: BRANDON KELLY BECK FNP

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	R186529	MD

General Provider Information

NPI Number	:	1548970023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON KELLY BECK FNP

Provider Business Mailing Address
First Line	:	1220 RABBIT HILL RD
Second Line	:
City	:	CHURCH HILL
State	:	MD
Zip	:	21623-1339
Country	:	US
Telephone Number	:	443-282-4248
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 RABBIT HILL RD
Second Line	:
City	:	CHURCH HILL
State	:	MD
Zip	:	21623-1339
Country	:	US
Telephone Number	:	443-282-4248
Fax Number	:

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

Provider Enumeration Date	:	11/25/2022
Last Update Date	:	11/25/2022

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