Provider Demographics
NPI:1063028512
Name:BECK, BOBBI JO (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:JO
Last Name:BECK
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-8226
Mailing Address - Country:US
Mailing Address - Phone:662-809-9252
Mailing Address - Fax:
Practice Address - Street 1:2504 BROWNING ROAD 520
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-6022
Practice Address - Country:US
Practice Address - Phone:662-453-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS892771163WP0808X
MS905594363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health