Provider Demographics
NPI:1063503159
Name:DE BECK, KARLA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:LYNN
Last Name:DE BECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1502 W NC HIGHWAY 54
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5571
Mailing Address - Country:US
Mailing Address - Phone:919-403-2122
Mailing Address - Fax:919-401-4993
Practice Address - Street 1:1502 W NC HIGHWAY 54
Practice Address - Street 2:SUITE 103
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5571
Practice Address - Country:US
Practice Address - Phone:919-403-2122
Practice Address - Fax:919-401-4993
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00636512084P0800X
PAMD067803L2084P0800X
MI43015014052084P0800X
SC835692084P0800X
KYTP9362084P0800X
MO20200042002084P0800X
ARE-129112084P0800X
NC95000562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902285Medicaid
2290779AMedicare ID - Type Unspecified
NC5902285Medicaid