Provider Demographics
NPI:1457670150
Name:BECK, STACY LEE (FNP, ARNP)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LEE
Last Name:BECK
Suffix:
Gender:F
Credentials:FNP, ARNP
Other - Prefix:MISS
Other - First Name:STACY
Other - Middle Name:LEE
Other - Last Name:HESSIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:PO BOX 39368
Mailing Address - Street 2:
Mailing Address - City:NINILCHIK
Mailing Address - State:AK
Mailing Address - Zip Code:99639-0368
Mailing Address - Country:US
Mailing Address - Phone:907-567-3970
Mailing Address - Fax:079-567-9002
Practice Address - Street 1:15765 KINGSLEY RD
Practice Address - Street 2:
Practice Address - City:NINILCHIK
Practice Address - State:AK
Practice Address - Zip Code:99639-9759
Practice Address - Country:US
Practice Address - Phone:907-567-3970
Practice Address - Fax:907-567-9002
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK29122163WW0000X
AK183312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0000XNursing Service ProvidersRegistered NurseWound Care