Provider Demographics
NPI:1568766657
Name:BECKMEYER, JESSICA WYNNE (FNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:WYNNE
Last Name:BECKMEYER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:WYNNE
Other - Last Name:NOYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2350 W. EL CAMINO REAL
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2950 WHIPPLE AVENUE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2850
Practice Address - Country:US
Practice Address - Phone:650-366-4633
Practice Address - Fax:650-364-0906
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19636363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily