Provider Demographics
NPI:1356649222
Name:BECK, ANDREA NACOLE (MS, RD/LD)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:NACOLE
Last Name:BECK
Suffix:
Gender:F
Credentials:MS, RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-4321
Mailing Address - Country:US
Mailing Address - Phone:405-273-2202
Mailing Address - Fax:405-273-2292
Practice Address - Street 1:1505 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-4321
Practice Address - Country:US
Practice Address - Phone:405-273-2202
Practice Address - Fax:405-273-2292
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK133V00000X
OK1651133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered