Provider Demographics
NPI:1598996795
Name:WARD, BECKY JO (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:JO
Last Name:WARD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:BECKY
Other - Middle Name:JO
Other - Last Name:HAAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:301 ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362
Mailing Address - Country:US
Mailing Address - Phone:800-261-7193
Mailing Address - Fax:334-255-7368
Practice Address - Street 1:301 ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362
Practice Address - Country:US
Practice Address - Phone:800-261-7193
Practice Address - Fax:334-255-7368
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-099630363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily