Provider Demographics
NPI:1477227890
Name:BECKETT, ISATA ADAMA (NP)
Entity Type:Individual
Prefix:MISS
First Name:ISATA
Middle Name:ADAMA
Last Name:BECKETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10214 INDEPENDENCE AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3097
Mailing Address - Country:US
Mailing Address - Phone:181-835-7333
Mailing Address - Fax:
Practice Address - Street 1:10214 INDEPENDENCE AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3097
Practice Address - Country:US
Practice Address - Phone:181-835-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA587569363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care