Provider Demographics
NPI:1891003216
Name:BECKER, KATHERINE ANN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ANN
Last Name:BECKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:ANN
Other - Last Name:KOLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 COUNTY ROAD 415
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-8906
Mailing Address - Country:US
Mailing Address - Phone:386-566-6244
Mailing Address - Fax:
Practice Address - Street 1:275 COUNTY ROAD 415
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-8906
Practice Address - Country:US
Practice Address - Phone:386-566-6244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9199728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily