Provider Demographics
NPI:1477161891
Name:BECKETT, DREAMA GAYLE
Entity Type:Individual
Prefix:MS
First Name:DREAMA
Middle Name:GAYLE
Last Name:BECKETT
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 1:1105 HILLTOP ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541-9374
Mailing Address - Country:US
Mailing Address - Phone:304-360-0285
Mailing Address - Fax:304-733-6486
Practice Address - Street 1:650 MAIN ST
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1439
Practice Address - Country:US
Practice Address - Phone:304-302-0707
Practice Address - Fax:304-733-6486
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant