Provider Demographics
NPI:1467809327
Name:BECKETT, STEPHANIE J (APRN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:BECKETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-1325
Mailing Address - Country:US
Mailing Address - Phone:606-526-8131
Mailing Address - Fax:606-528-8664
Practice Address - Street 1:120 N COMMONWEALTH AVE
Practice Address - Street 2:STE. 1
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-6472
Practice Address - Country:US
Practice Address - Phone:606-258-2160
Practice Address - Fax:606-258-2162
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3011263363LF0000X
TN00000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK226260Medicare PIN