Provider Demographics
NPI:1942665161
Name:BECKMAN, EMILY KATHLEEN (APRN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHLEEN
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:APRN
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 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:2355 POPLAR LEVEL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1395
Practice Address - Country:US
Practice Address - Phone:502-696-7444
Practice Address - Fax:502-636-7340
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009734363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100391390Medicaid
KY50103452OtherPASSPORT
KY000001006310OtherANTHEM
KYK143780Medicare PIN