Provider Demographics
NPI:1699368852
Name:BECK, ANGELA CRYSTAL (NP-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CRYSTAL
Last Name:BECK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 CARROLL AVE
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-2429
Mailing Address - Country:US
Mailing Address - Phone:620-285-3161
Mailing Address - Fax:
Practice Address - Street 1:923 CARROLL AVE
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-2429
Practice Address - Country:US
Practice Address - Phone:620-285-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79898-062363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner