Provider Demographics
NPI:1245077023
Name:BECKER, KAYLEEN FAYE (FNP-C)
Entity type:Individual
Prefix:
First Name:KAYLEEN
Middle Name:FAYE
Last Name:BECKER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2848 E BROWN RD UNIT 13
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-5412
Mailing Address - Country:US
Mailing Address - Phone:423-432-5773
Mailing Address - Fax:
Practice Address - Street 1:3295 N DRINKWATER BLVD STE 3
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6437
Practice Address - Country:US
Practice Address - Phone:480-621-8638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN245990163W00000X
CA95370170163W00000X
AZ310324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse