Provider Demographics
NPI:1164849865
Name:AHMED, BECKY L (NP-C)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:L
Last Name:AHMED
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:L
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:364 SE 8TH AVE STE 108A
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4253
Mailing Address - Country:US
Mailing Address - Phone:503-640-3687
Mailing Address - Fax:503-640-3688
Practice Address - Street 1:364 SE 8TH AVE STE 108A
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4253
Practice Address - Country:US
Practice Address - Phone:503-640-3687
Practice Address - Fax:503-640-3688
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH073384-23363L00000X
CT113681363L00000X
CT5683363LA2200X
OR202201769NP-PP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner