Provider Demographics
NPI:1548207186
Name:BECK, JUDITH A (FNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:BECK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1288 EISENHOWER RD
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5532
Mailing Address - Country:US
Mailing Address - Phone:913-727-1039
Mailing Address - Fax:888-309-9759
Practice Address - Street 1:1288 EISENHOWER RD
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5532
Practice Address - Country:US
Practice Address - Phone:913-727-1039
Practice Address - Fax:888-309-9759
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44671-122363LF0000X
KS53-44671363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4286006304Medicaid
KSB46A809BMedicare ID - Type UnspecifiedEMERGENCY MEDICAL SERVICE
KS4286006304Medicaid