Provider Demographics
NPI:1114274545
Name:BECKHAM, ANNALISA KAY (FNP)
Entity Type:Individual
Prefix:
First Name:ANNALISA
Middle Name:KAY
Last Name:BECKHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-3751
Mailing Address - Country:US
Mailing Address - Phone:417-894-3263
Mailing Address - Fax:
Practice Address - Street 1:3423 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-3751
Practice Address - Country:US
Practice Address - Phone:417-894-3263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012026933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012026933OtherNP LICENSE
MO2012026933OtherNP LICENSE