Provider Demographics
NPI:1134298193
Name:BECKETT, DAVID RAY (RNFA,MSN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RAY
Last Name:BECKETT
Suffix:
Gender:M
Credentials:RNFA,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 N.TIMBERLINE RD.
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7550
Mailing Address - Country:US
Mailing Address - Phone:928-522-8588
Mailing Address - Fax:928-522-0654
Practice Address - Street 1:2333 N TIMBERLINE RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-7550
Practice Address - Country:US
Practice Address - Phone:928-522-8588
Practice Address - Fax:928-522-0654
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN095065163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0146500OtherBCBS PROVIDER NUMBER
CA363L00000XOtherNIFA MEDICAL BILLING