Provider Demographics
NPI:1629418553
Name:BECK, NATAILLE CHEREE (ANP)
Entity Type:Individual
Prefix:MRS
First Name:NATAILLE
Middle Name:CHEREE
Last Name:BECK
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:HATTIEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72063-0006
Mailing Address - Country:US
Mailing Address - Phone:501-977-0102
Mailing Address - Fax:501-977-0120
Practice Address - Street 1:38 MARTY LN
Practice Address - Street 2:
Practice Address - City:HATTIEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72063-8930
Practice Address - Country:US
Practice Address - Phone:501-977-0102
Practice Address - Fax:501-977-0120
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARF0513126363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARF0513126OtherAPN CERTIFICATE NUMBER
ARR063440OtherRN LICENSE NUMBER
ARA003889OtherAPN LICENSE