Provider Demographics
NPI:1922343128
Name:BECKETT, ERIKA LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:LEIGH
Last Name:BECKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5495 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25840-6872
Mailing Address - Country:US
Mailing Address - Phone:304-574-0120
Mailing Address - Fax:
Practice Address - Street 1:5495 MAPLE LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840-6872
Practice Address - Country:US
Practice Address - Phone:304-574-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV26559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1922343128Medicaid
WV1922343128Medicaid
WVWV6416B441Medicare PIN
WVB441OtherMEDICARE-GROUP