Provider Demographics
NPI:1043631229
Name:BECKER, CHELSEY JO (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEY
Middle Name:JO
Last Name:BECKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:CHELSEY
Other - Middle Name:JO
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:1303 SHOREWINDS TRL
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4835
Mailing Address - Country:US
Mailing Address - Phone:573-979-5574
Mailing Address - Fax:
Practice Address - Street 1:400 MID RIVERS MALL DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1577
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-14
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017000667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2010040212OtherMISSOURI STATE BOARD OF NURSING