Provider Demographics
NPI:1417366188
Name:D'AGOSTINO, BECKY LYNN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:LYNN
Last Name:D'AGOSTINO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DOC LN
Mailing Address - Street 2:
Mailing Address - City:MANSON
Mailing Address - State:NC
Mailing Address - Zip Code:27553-9083
Mailing Address - Country:US
Mailing Address - Phone:906-395-7121
Mailing Address - Fax:
Practice Address - Street 1:100 W PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536
Practice Address - Country:US
Practice Address - Phone:252-438-3549
Practice Address - Fax:252-438-2084
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010712363LF0000X
MI4704155616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily