Provider Demographics
NPI:1972061091
Name:BECKSTROM, KRISTIE
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:
Last Name:BECKSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5527 STEWART ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-4303
Mailing Address - Country:US
Mailing Address - Phone:850-983-5200
Mailing Address - Fax:
Practice Address - Street 1:5527 STEWART ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4303
Practice Address - Country:US
Practice Address - Phone:850-983-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator