Provider Demographics
NPI:1285181289
Name:BECKER, AUDREY ANN
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ANN
Last Name:BECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:1649 WESTGATE CIR
Practice Address - Street 2:#100
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8574
Practice Address - Country:US
Practice Address - Phone:615-843-7546
Practice Address - Fax:615-777-3376
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6089376OtherBCBS TN
TNQ025828Medicaid
TN6089376OtherBCBS TN