Provider Demographics
NPI:1124227723
Name:BECK, JENNIFER L (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:BECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:D
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 WIND HAVEN DR STE 104
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8036
Mailing Address - Country:US
Mailing Address - Phone:314-888-5233
Mailing Address - Fax:318-232-5983
Practice Address - Street 1:101 WIND HAVEN DR STE 104
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8036
Practice Address - Country:US
Practice Address - Phone:314-888-5233
Practice Address - Fax:318-232-5983
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100019190Medicaid
KYK054500Medicare PIN